Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: a systematic review.
Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: a systematic review.
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DOI：
10.1186/s12877-021-02050-y
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发表时间：
2021-02-06
期刊：
影响因子：
4.1
通讯作者：
Scholte Op Reimer WJM
中科院分区：
文献类型：
--
作者：
Pel-Littel RE;Snaterse M;Teppich NM;Buurman BM;van Etten-Jamaludin FS;van Weert JCM;Minkman MM;Scholte Op Reimer WJM
本研究旨在描述患有多种慢性病（MCCs）的老年患者、非正式照顾者以及卫生专业人员所经历的共同决策（SDM）的障碍和促进因素。
在5个数据库中进行了结构化文献检索。两名评审员独立评估研究的合格性并进行质量评估。使用预先定义的分类法对纳入研究的结果进行总结。
我们的检索共得到3838篇文章。纳入了28项研究，其中列出了149个感知到的共同决策障碍和67个感知到的促进因素。由于健康状况不佳以及认知和/或身体损伤，患有多种慢性病的老年患者较少参与共同决策。卫生专业人员人际交往能力差被认为阻碍了共同决策，时间压力和患者高流动率等组织障碍也是如此。然而，在患有多种慢性病的老年患者中，当患者分享个人价值观、优先事项和偏好以及生活质量和功能状态等信息时，共同决策可能会得到促进。非正式照顾者可以通过协助患者进行决策支持来促进共同决策，尽管非正式照顾者也可能使共同决策过程复杂化，例如当他们对治疗或患者的参与能力有不同看法时。当涉及多个卫生专业人员时，护理协调被认为是重要的。
尽管健康状况不佳被视为参与共同决策的障碍，但患有多种慢性病的个人生活经历被认为是共同决策中有价值的投入。明确邀请老年人参与共同决策很重要。卫生专业人员需要有利的组织环境和良好的沟通技能，以便为患者护理制定个性化方法。
网络版包含补充材料，可在10.1186/s12877 - 021 - 02050 - y获取。
The aim of this study was to describe barriers and facilitators for shared decision making (SDM) as experienced by older patients with multiple chronic conditions (MCCs), informal caregivers and health professionals. A structured literature search was conducted with 5 databases. Two reviewers independently assessed studies for eligibility and performed a quality assessment. The results from the included studies were summarized using a predefined taxonomy. Our search yielded 3838 articles. Twenty-eight studies, listing 149 perceived barriers and 67 perceived facilitators for SDM, were included. Due to poor health and cognitive and/or physical impairments, older patients with MCCs participate less in SDM. Poor interpersonal skills of health professionals are perceived as hampering SDM, as do organizational barriers, such as pressure for time and high turnover of patients. However, among older patients with MCCs, SDM could be facilitated when patients share information about personal values, priorities and preferences, as well as information about quality of life and functional status. Informal caregivers may facilitate SDM by assisting patients with decision support, although informal caregivers can also complicate the SDM process, for example, when they have different views on treatment or the patient’s capability to be involved. Coordination of care when multiple health professionals are involved is perceived as important. Although poor health is perceived as a barrier to participate in SDM, the personal experience of living with MCCs is considered valuable input in SDM. An explicit invitation to participate in SDM is important to older adults. Health professionals need a supporting organizational context and good communication skills to devise an individualized approach for patient care. The online version contains supplementary material available at 10.1186/s12877-021-02050-y.
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