背景:基于Web的决策辅助工具已被证明在用于提高面临乳房切除术后乳房再造(PMBR)的女性的决策质量时具有积极作用。然而,关于这些干预措施的现有发现仍然不一致,总体效果尚不清楚。
目标:我们旨在评估基于网络的决策辅助工具的内容及其对决策相关结果的影响(即,决策冲突,决定后悔,明智的选择,和知识),与心理相关的结果(即,满意度和焦虑),以及面临PMBR的女性的手术决策。
方法:本系统评价和荟萃分析遵循PRISMA(系统评价和荟萃分析的首选报告项目)指南。共有6个数据库,PubMed,Embase,科克伦图书馆,CINAHL,PsycINFO,和WebofScience核心合集,从建立数据库到2023年5月开始进行搜索,并于2024年4月1日进行了更新搜索。使用MeSH(医学主题词)术语和文本单词。随机对照试验的Cochrane偏倚风险工具用于评估偏倚风险。使用建议分级评估证据的确定性,评估,发展,和评价方法。
结果:总计,7项研究包括579名女性,发表于2008年至2023年之间,每项研究的样本量从26到222不等。结果表明,基于网络的决策辅助工具使用音频和视频来展示PMBR与没有PMBR的优缺点,植入物与皮瓣,以及即时与延迟的PMBR以及PMBR结果的外观和感觉以及实际患者的照片的预期恢复时间。基于Web的决策辅助工具有助于提高PMBR知识,决策冲突(平均差[MD]=-5.43,95%CI-8.87至-1.99;P=0.002),和满意度(标准化MD=0.48,95%CI0.00至0.95;P=0.05),但对知情选择没有影响(MD=-2.80,95%CI-8.54至2.94;P=.34),决策后悔(MD=-1.55,95%CI-6.00至2.90P=0.49),或焦虑(标准化MD=0.04,95%CI-0.50至0.58;P=0.88)。建议的总体等级,评估,发展,证据评价质量较低。
结论:研究结果表明,基于网络的决策辅助工具提供了现代,低成本,以及高传播率的有效方法,以促进接受PMBR的妇女决策质量的提高。
背景:PROSPEROCRD42023450496;https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=450496。
BACKGROUND: Web-based decision aids have been shown to have a positive effect when used to improve the quality of decision-making for women facing postmastectomy breast reconstruction (PMBR). However, the existing findings regarding these interventions are still incongruent, and the overall effect is unclear.
OBJECTIVE: We aimed to assess the content of web-based decision aids and its impact on decision-related outcomes (ie, decision conflict, decision regret, informed choice, and knowledge), psychological-related outcomes (ie, satisfaction and anxiety), and surgical decision-making in women facing PMBR.
METHODS: This systematic
review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 6 databases, PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science Core Collection, were searched starting at the time of establishment of the databases to May 2023, and an updated search was conducted on April 1, 2024. MeSH (Medical Subject Headings) terms and text words were used. The Cochrane Risk of Bias Tool for randomized controlled trials was used to assess the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.
RESULTS: In total, 7 studies included 579 women and were published between 2008 and 2023, and the sample size in each study ranged from 26 to 222. The results showed that web-based decision aids used audio and video to present the pros and cons of PMBR versus no PMBR, implants versus flaps, and immediate versus delayed PMBR and the appearance and feel of the PMBR results and the expected recovery time with photographs of actual patients. Web-based decision aids help improve PMBR knowledge, decisional conflict (mean difference [MD]=-5.43, 95% CI -8.87 to -1.99; P=.002), and satisfaction (standardized MD=0.48, 95% CI 0.00 to 0.95; P=.05) but have no effect on informed choice (MD=-2.80, 95% CI -8.54 to 2.94; P=.34), decision regret (MD=-1.55, 95% CI -6.00 to 2.90 P=.49), or anxiety (standardized MD=0.04, 95% CI -0.50 to 0.58; P=.88). The overall Grading of Recommendations, Assessment, Development, and Evaluation quality of the evidence was low.
CONCLUSIONS: The findings suggest that the web-based decision aids provide a modern, low-cost, and high dissemination rate effective method to promote the improved quality of decision-making in women undergoing PMBR.
BACKGROUND: PROSPERO CRD42023450496; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=450496.