Patient Preferences and Shared Decision Making in the Treatment of Substance Use Disorders: A Systematic Review of the Literature.
Patient Preferences and Shared Decision Making in the Treatment of Substance Use Disorders: A Systematic Review of the Literature.
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DOI：
10.1371/journal.pone.0145817
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Buchholz A
中科院分区：
文献类型：
--
作者：
Friedrichs A;Spies M;Härter M;Buchholz A
共享决策(SDM)作为患者参与医疗决策的手段，越来越受到治疗指南和立法的要求。此外，将患者的偏好与治疗相匹配已被证明在减轻症状方面是有效的。尽管药物使用障碍(SUD)患者的结果令人振奋，但尚未提供文献的系统评估。因此，其目的是给出一个系统的文献综述患者的喜好和SDM治疗的SUD患者。对Medline、Embase、Psyndex和临床试验注册数据库进行电子文献检索。使用了不同的搜索词：物质使用障碍、患者偏好和SDM。为了综合数据，根据PRISMA声明对人群、干预措施和结果进行了总结和描述。采用混合方法评价工具对纳入文献的方法学质量进行评价。N=25个试验纳入本综述。这些研究是在1986年至2014年间进行的，总共有8.729名患者。两项研究发现，SUD患者更愿意积极参与治疗决策。在n=18项研究中评估了治疗偏好，与住院治疗相比，大多数患者更喜欢门诊治疗。将患者与喜好匹配导致物质使用的减少(n=3项研究)，但大多数研究发现没有显著影响。SDM的干预措施因患者群体和可选治疗技术而异。与其他健康状况的患者一样，有药物使用障碍的患者也应该参与医疗决策。一个合适的方法是共享决策，强调患者的偏好。然而，由于纳入研究的异质性，对结果的解释应谨慎。需要对药物使用障碍患者群体中的SDM干预进行进一步的研究。
Shared Decision Making (SDM) as means to the involvement of patients in medical decision making is increasingly demanded by treatment guidelines and legislation. Also, matching of patients’ preferences to treatments has been shown to be effective regarding symptom reduction. Despite promising results for patients with substance use disorders (SUD) no systematic evaluation of the literature has been provided. The aim is therefore to give a systematic overview of the literature of patient preferences and SDM in the treatment of patients with SUD. An electronic literature search of the databases Medline, Embase, Psyndex and Clinical Trials Register was performed. Variations of the search terms substance use disorders, patient preferences and SDM were used. For data synthesis the populations, interventions and outcomes were summarized and described according to the PRISMA statement. Methodological quality of the included articles was assessed with the Mixed Methods Appraisal Tool. N = 25 trials were included in this review. These were conducted between 1986 and 2014 with altogether n = 8.729 patients. Two studies found that patients with SUD preferred to be actively involved in treatment decisions. Treatment preferences were assessed in n = 18 studies, where the majority of patients preferred outpatient compared with inpatient treatment. Matching patients to preferences resulted in a reduction on substance use (n = 3 studies), but the majority of studies found no significant effect. Interventions for SDM differed across patient populations and optional therapeutic techniques. Patients with substance use disorders should be involved in medical treatment decisions, as patients with other health conditions. A suitable approach is Shared Decision Making, emphasizing the patients’ preferences. However, due to the heterogeneity of the included studies, results should be interpreted with caution. Further research is needed regarding SDM interventions in patient populations with substance use disorders.