Shared Decision Making and Choice for Elective Surgical Care: A Systematic Review.
Shared Decision Making and Choice for Elective Surgical Care: A Systematic Review.
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DOI：
10.1177/0194599815620558
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发表时间：
2016-03
期刊：
影响因子：
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通讯作者：
Lipstein EA
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文献类型：
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作者：
Boss EF;Mehta N;Nagarajan N;Links A;Benke JR;Berger Z;Espinel A;Meier J;Lipstein EA
共享决策 (SDM) 是一种综合的患者与提供者沟通过程，强调科学证据和患者/家庭价值观的讨论，可以提高护理服务质量，促进循证实践，并减少手术护理的过度使用。然而，对于择期手术实践中的 SDM 知之甚少。本系统评价的目的是综合评估择期手术中 SDM 的使用和结果的研究结果。 Pubmed、CochraneCENTRAL、EMBASE、CINAHL 和 SCOPUS 电子数据库 我们检索了评估 SDM 在择期手术护理中使用的英语研究（1990 年 1 月 1 日至 2015 年 8 月 9 日）。确定的研究由两名评审员在标题/摘要和全文评审阶段独立筛选。我们提取了与人群、研究设计、临床困境、SDM 的使用、结果、治疗选择和偏倚相关的数据。在 10,929 篇已识别文章中，24 篇符合纳入标准。最常见的研究领域是脊柱（7/24），其次是关节（5/24）和妇科手术（4/24）。二十项研究使用了决策辅助/支持工具，包括多媒体/视频 (13/20)、书面 (3/20) 或个人辅导 (4/20) 的方式。 SDM 对手术偏好的影响在各项研究中参差不齐，显示手术次数减少 (9/24)、无差异 (8/24) 或增加 (1/24)。 SDM 倾向于提高决策质量 (3/3) 以及知识/准备 (4/6)，同时减少决策冲突 (4/6)。 SDM 减少了患者选择择期手术时的决策冲突并提高了决策质量。虽然最终结果表明 SDM 可能会影响患者较少选择手术，但 SDM 对手术利用率的影响尚无法明确确定。
Shared Decision-Making (SDM), an integrative patient-provider communication process emphasizing discussion of scientific evidence and patient/family values, may improve quality care delivery, promote evidence-based practice, and reduce overuse of surgical care. Little is known however regarding SDM in elective surgical practice. The purpose of this systematic review is to synthesize findings of studies evaluating use and outcomes of SDM in elective surgery. Pubmed, CochraneCENTRAL, EMBASE, CINAHL, and SCOPUS electronic databases We searched for English-language studies (1/1/1990 to 8/9/2015) evaluating use of SDM in elective surgical care. Identified studies were independently screened by two reviewers in stages of title/abstract and full-text review. We abstracted data related to population, study design, clinical dilemma, use of SDM, outcomes, treatment choice, and bias. Of 10,929 identified articles, 24 met inclusion criteria. The most common area studied was spine (7/24) followed by joint (5/24) and gynecological surgery (4/24). Twenty studies used decision aids/support tools, including modalities that were multimedia/video (13/20), written (3/20), or personal coaching (4/20). Effect of SDM on preference for surgery were mixed across studies, showing a decrease in surgery (9/24), no difference (8/24), or increase (1/24). SDM tended to improve decision quality (3/3) as well as knowledge/preparation (4/6), while decreasing decision conflict (4/6). SDM reduces decision conflict and improves decision quality for patients making choices about elective surgery. While net findings show that SDM may influence patients to choose surgery less often, the impact of SDM on surgical utilization cannot be clearly ascertained.