Evidence-Based Risk Communication A Systematic Review
Evidence-Based Risk Communication A Systematic Review
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DOI：
10.7326/m14-0295
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发表时间：
2014-08-19
影响因子：
39.2
通讯作者：
Feldstein, David A.
中科院分区：
文献类型：
--
作者：
Zipkin, Daniella A.;Umscheid, Craig A.;Feldstein, David A.
背景资料：风险和利益的有效沟通对患者的共同决策至关重要。目的：审查与患者沟通概率信息的方法的比较有效性，以最大限度地提高他们的认知和行为结果。数据来源：PubMed（1966年至2014年3月）和CINAHL，EMBASE，和科克伦对照试验中心注册中心（1966年至2011年12月）使用几个关键词和结构化的术语。研究选择：前瞻性或横断面研究，招募患者或健康志愿者，并将任何概率信息交流方法与另一种方法进行比较。数据提取：两名独立评审员提取研究特征并评估偏倚风险。数据合成：84篇文章，代表91个独特的研究，评估了各种方法的数字和视觉风险显示在几个风险场景和不同的结果措施。研究表明，视觉辅助工具（图标阵列和条形图）提高了患者的理解和满意度。在最大化准确性方面，包括绝对风险降低的介绍优于包括相对风险降低的介绍，并且似乎不太可能比相对风险降低的介绍影响接受治疗的决定。数字的呈现需要治疗理解力下降。比较效果的介绍频率（如1在5）与事件发生率（百分比，如20%）是inconclusion.Limitation：大多数研究是小的，高度可变的设置，上下文和方法管理interventions.Conclusion：视觉教具和绝对风险格式可以提高患者的概率信息的理解，而需要治疗的数字可以减少他们的理解。由于研究的异质性，任何单一方法传达概率信息的优越性都不确定，但有几个很好的选择来帮助临床医生与患者沟通。
Background: Effective communication of risks and benefits to patients is critical for shared decision making.Purpose: To review the comparative effectiveness of methods of communicating probabilistic information to patients that maximize their cognitive and behavioral outcomes.Data Sources: PubMed (1966 to March 2014) and CINAHL, EMBASE, and the Cochrane Central Register of Controlled Trials (1966 to December 2011) using several keywords and structured terms.Study Selection: Prospective or cross-sectional studies that recruited patients or healthy volunteers and compared any method of communicating probabilistic information with another method.Data Extraction: Two independent reviewers extracted study characteristics and assessed risk of bias.Data Synthesis: Eighty-four articles, representing 91 unique studies, evaluated various methods of numerical and visual risk display across several risk scenarios and with diverse outcome measures. Studies showed that visual aids (icon arrays and bar graphs) improved patients' understanding and satisfaction. Presentations including absolute risk reductions were better than those including relative risk reductions for maximizing accuracy and seemed less likely than presentations with relative risk reductions to influence decisions to accept therapy. The presentation of numbers needed to treat reduced understanding. Comparative effects of presentations of frequencies (such as 1 in 5) versus event rates (percentages, such as 20%) were inconclusive.Limitation: Most studies were small and highly variable in terms of setting, context, and methods of administering interventions.Conclusion: Visual aids and absolute risk formats can improve patients' understanding of probabilistic information, whereas numbers needed to treat can lessen their understanding. Due to study heterogeneity, the superiority of any single method for conveying probabilistic information is not established, but there are several good options to help clinicians communicate with patients.