Incorporating the patient perspective: a critical review of clinical practice guidelines for implantable cardioverter defibrillator therapy.
Incorporating the patient perspective: a critical review of clinical practice guidelines for implantable cardioverter defibrillator therapy.
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纳入患者观点：对植入式心律转复除颤器治疗临床实践指南的严格审查。
DOI：
10.1007/s10840-012-9762-6
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Thomson,Richard
中科院分区：
文献类型：
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作者：
Joyce,KerryE;Lord,Stephen;Matlock,DanielD;McComb,JanetM;Thomson,Richard
植入式心脏复律除颤器（ICD）被推荐用于有心脏性猝死风险的心力衰竭和/或室性心律失常患者。ICD植入指南来自可靠的临床数据。然而，可能影响治疗决策的关键因素包括患者的偏好。我们着手确定如何临床实践指南（CPGs）纳入患者的角度来支持决策ICDs.MethodsCPGs对ICD植入有目的地选择在欧洲，北美和澳大拉西亚的国家和专业机构。CPG，然后评估根据三个关键领域的共同决策：（一）告知患者的风险，利益和后果已知是重要的患者;（B）个性化的风险和利益和（c）参与患者（加家庭/重要的其他人，如果需要）在decisionmaking. ResultsAssessment六个当前CPG发现重大缺陷或不一致的指导。CPG倾向于关注器械有效性的证据，很少考虑对患者重要的其他结局，例如对生活质量和心理健康的影响。很少有人提到参与的病人在decisionmaking.ConclusionsThis表明，嵌入共享的决定在CPGs将提高以患者为中心的ICD治疗，使患者作出知情的，基于价值的决定。CPG开发的具体建议包括需要标记偏好敏感决策点，以及在决定是否安装器械时纳入已知对患者重要的更广泛结局。
PurposeImplantable cardioverter defibrillators (ICDs) are recommended for patients with heart failure and/or ventricular arrhythmias at risk of sudden cardiac death. Guidelines for ICD implantation are derived from robust clinical data. However, critical factors which might influence treatment decisions include patient preferences. We set out to determine how clinical practice guidelines (CPGs) incorporate the patient perspective into supporting decision making about ICDs.MethodsCPGs on ICD implantation were purposively selected from national and professional bodies in Europe, North America and Australasia. CPGs were then appraised according to three key domains of shared decision making: (a) informing patients about the risks, benefits and consequences known to be important to patients; (b) personalising risks and benefits and (c) involvement of patient (plus family/significant others if desired) in decision making.ResultsAppraisal of six current CPGs found major deficiencies or inconsistencies in guidance. CPGs tended to focus on evidence of device effectiveness, with sparse consideration of other outcomes important to patients such as impacts on quality of life and psychosocial well-being. Little reference was made to involvement of the patient in decision making.ConclusionsThis suggests that embedding shared decision in CPGs will improve the patient-centeredness of ICD treatment by enabling patients to make informed, value-based decisions. Specific recommendations for CPG development include the need for signposting to preference sensitive decision points as well as inclusion of a broader range of outcomes which are known to be important to patients when deciding whether or not to have a device fitted.