Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis.
Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0094670
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Elwyn G
中科院分区：
文献类型：
--
作者：
Durand MA;Carpenter L;Dolan H;Bravo P;Mann M;Bunn F;Elwyn G
增加患者对医疗保健的参与已成为卫生政策的优先事项。然而，有人担心，促进有支持的共同决策可能会增加健康不平等。评估可持续发展机制干预措施对弱势群体和健康不平等的影响。随机对照试验和观察性研究的系统综述和荟萃分析。检索了CINAHL、科克伦对照试验登记系统、科克伦系统评价数据库、EMBASE、HMIC、MEDLINE、NHS经济评价数据库、Open SIGLE、PsycINFO和Web of Knowledge，检索时间从开始到2012年6月。我们纳入了所有符合以下两个标准的研究，没有语言限制：（1）评估共同决策干预对弱势群体和/或健康不平等的影响，（2）包括至少50%的弱势群体，除非对这一群体进行单独分析。我们纳入了19项研究，并在荟萃分析中汇总了10项研究。荟萃分析显示，共同决策干预对弱势患者有中度积极影响。叙述性综合研究表明，总体而言，SDM干预措施增加了知识，知情选择，参与决策，决策自我效能，偏好协作决策和减少决策冲突的弱势患者。此外，19项研究中有7项比较了高识字率和低识字率群体之间的干预效果。总体而言，可持续发展机制干预措施似乎使弱势群体（例如识字率较低的群体）比识字率、教育程度和社会经济地位较高的群体受益更多。适合弱势群体需要的干预措施似乎最为有效。结果表明，共同决策干预措施显着改善弱势患者的结果。根据叙述综合，SDM干预措施可能更有利于弱势群体比较高的识字/社会经济地位的患者。然而，鉴于样本量小，干预类型、研究设计和质量多样，应谨慎解释这些结果。
Increasing patient engagement in healthcare has become a health policy priority. However, there has been concern that promoting supported shared decision-making could increase health inequalities. To evaluate the impact of SDM interventions on disadvantaged groups and health inequalities. Systematic review and meta-analysis of randomised controlled trials and observational studies. CINAHL, the Cochrane Register of Controlled Trials, the Cochrane Database of Systematic Reviews, EMBASE, HMIC, MEDLINE, the NHS Economic Evaluation Database, Open SIGLE, PsycINFO and Web of Knowledge were searched from inception until June 2012. We included all studies, without language restriction, that met the following two criteria: (1) assess the effect of shared decision-making interventions on disadvantaged groups and/or health inequalities, (2) include at least 50% of people from disadvantaged groups, except if a separate analysis was conducted for this group. We included 19 studies and pooled 10 in a meta-analysis. The meta-analyses showed a moderate positive effect of shared decision-making interventions on disadvantaged patients. The narrative synthesis suggested that, overall, SDM interventions increased knowledge, informed choice, participation in decision-making, decision self-efficacy, preference for collaborative decision making and reduced decisional conflict among disadvantaged patients. Further, 7 out of 19 studies compared the intervention's effect between high and low literacy groups. Overall, SDM interventions seemed to benefit disadvantaged groups (e.g. lower literacy) more than those with higher literacy, education and socioeconomic status. Interventions that were tailored to disadvantaged groups' needs appeared most effective. Results indicate that shared decision-making interventions significantly improve outcomes for disadvantaged patients. According to the narrative synthesis, SDM interventions may be more beneficial to disadvantaged groups than higher literacy/socioeconomic status patients. However, given the small sample sizes and variety in the intervention types, study design and quality, those findings should be interpreted with caution.
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