Systematic review of clinician-directed nudges in healthcare contexts.
Systematic review of clinician-directed nudges in healthcare contexts.
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DOI：
10.1136/bmjopen-2021-048801
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发表时间：
2021-07-12
期刊：
影响因子：
2.9
通讯作者：
Beidas RS
中科院分区：
文献类型：
--
作者：
Last BS;Buttenheim AM;Timon CE;Mitra N;Beidas RS
助推是改变选项呈现方式的干预措施，使个人能够更容易地选择最佳选项。卫生系统和研究人员已经测试了轻推来塑造临床医生的决策，目的是改善医疗服务的提供。我们的目的是系统地研究的使用和有效性的轻推，旨在改善临床医生的决定，在医疗保健设置。进行了一项系统性综述，以收集和巩固来自测试轻推的研究的结果，并确定针对不同临床医生类型的医疗保健环境中改善临床决策的轻推是否有效。我们系统地检索了7个数据库（EBSCO MegaFILE、EconLit、Embase、PsycINFO、PubMed、Scopus和Web of Science），并使用滚雪球抽样技术识别1984年1月1日至2020年4月22日期间发表的同行评审研究。合格的研究进行了严格的评价和叙事合成。我们根据纳菲尔德生物伦理学理事会的分类法对轻推进行了分类。使用科克伦偏倚风险评估工具对纳入的研究进行评价。我们筛选了3608项研究，39项研究符合我们的标准。大多数研究（90%）在美国进行，36%为随机对照试验。最常研究的轻推干预（46%）为临床医生提供信息，通常通过同行比较反馈。通过默认选项或启用选择来指导临床决策的推动也经常被研究（31%）。信息框架，默认和使选择轻推显示的承诺，而其他类型的轻推的有效性是混合的。考虑到纳入了非实验设计，只有一小部分研究在所有科克伦标准下的偏倚风险最小（33%）。框架信息，改变默认选项或启用选择的轻推经常被研究，并显示出改善临床决策的希望。未来的工作应该研究如何轻推相比，非轻推干预（例如，政策干预）在改善医疗保健。
Nudges are interventions that alter the way options are presented, enabling individuals to more easily select the best option. Health systems and researchers have tested nudges to shape clinician decision-making with the aim of improving healthcare service delivery. We aimed to systematically study the use and effectiveness of nudges designed to improve clinicians’ decisions in healthcare settings. A systematic review was conducted to collect and consolidate results from studies testing nudges and to determine whether nudges directed at improving clinical decisions in healthcare settings across clinician types were effective. We systematically searched seven databases (EBSCO MegaFILE, EconLit, Embase, PsycINFO, PubMed, Scopus and Web of Science) and used a snowball sampling technique to identify peer-reviewed published studies available between 1 January 1984 and 22 April 2020. Eligible studies were critically appraised and narratively synthesised. We categorised nudges according to a taxonomy derived from the Nuffield Council on Bioethics. Included studies were appraised using the Cochrane Risk of Bias Assessment Tool. We screened 3608 studies and 39 studies met our criteria. The majority of the studies (90%) were conducted in the USA and 36% were randomised controlled trials. The most commonly studied nudge intervention (46%) framed information for clinicians, often through peer comparison feedback. Nudges that guided clinical decisions through default options or by enabling choice were also frequently studied (31%). Information framing, default and enabling choice nudges showed promise, whereas the effectiveness of other nudge types was mixed. Given the inclusion of non-experimental designs, only a small portion of studies were at minimal risk of bias (33%) across all Cochrane criteria. Nudges that frame information, change default options or enable choice are frequently studied and show promise in improving clinical decision-making. Future work should examine how nudges compare to non-nudge interventions (eg, policy interventions) in improving healthcare.
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