Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review.
Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review.
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DOI：
10.1136/bmjqs-2018-008022
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发表时间：
2019-06
影响因子：
5.4
通讯作者：
Montori VM
中科院分区：
文献类型：
--
作者：
Dobler CC;Sanchez M;Gionfriddo MR;Alvarez-Villalobos NA;Singh Ospina N;Spencer-Bonilla G;Thorsteinsdottir B;Benkhadra R;Erwin PJ;West CP;Brito JP;Murad MH;Montori VM
临床医生对就诊决策辅助工具的满意度是促进这些工具实施的重要组成部分。旨在确定在临床诊疗过程中支持共享决策的决策辅助工具对临床医生结局的影响。我们检索了从成立到2017年6月的9个数据库。在与独立对照组的临床接触期间使用的决策辅助工具的随机临床试验（RCT）有资格入选。由于纳入研究的异质性，我们使用了叙述性证据合成方法。25篇论文符合纳入标准，包括22项RCT和3项嵌套在RCT中的定性或混合方法研究，共代表23项独特的试验。这些试验评估了心血管预防和治疗（n=8）、糖尿病治疗（n=3）、骨质疏松症治疗（n = 2）、抑郁症治疗（n =2）、抗生素治疗急性呼吸道感染（n=3）、癌症预防和治疗（n=4）和产前诊断（n=1）的医疗保健决策。仅在少数研究中测量了临床医生结局。只有8项试验评估了临床医生对决策的满意度（其中只有2项试验显示对决策辅助工具的满意度在统计学上显著更高）;只有3项试验询问临床医生是否会向同事推荐决策辅助工具，只有5项试验询问临床医生是否会在未来使用决策辅助工具。在13项试验中，有9项使用了决策辅助工具，门诊咨询没有延长。证据的总体强度较低，主要偏倚风险与参与者和/或结局评估者未设盲有关。决策辅助工具可以提高临床医生对医疗决策的满意度，并在不影响咨询时间的情况下提供有用的信息。然而，大多数共享决策试验忽略了与临床医生对决策过程的观点或未来使用决策辅助的可能性相关的结果。
Clinicians’ satisfaction with encounter decision aids is an important component in facilitating implementation of these tools. To determine the impact of decision aids supporting shared decision making during the clinical encounter on clinician outcomes. We searched 9 databases from inception to June 2017. Randomised clinical trials (RCTs) of decision aids used during clinical encounters with an unaided control group were eligible for inclusion. Due to heterogeneity among included studies we used a narrative evidence synthesis approach. Twenty-five papers met inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials. These trials evaluated health care decisions for cardiovascular prevention and treatment (n=8), treatment of diabetes mellitus (n=3), treatment of osteoporosis (n=2), treatment of depression (n=2), antibiotics to treat acute respiratory infections (n=3), cancer prevention and treatment (n=4), and prenatal diagnosis (n=1). Clinician outcomes were measured in only a minority of studies. Clinicians’ satisfaction with decision making was assessed in only 8 (and only 2 of them showed statistically significantly greater satisfaction with the decision aid); only 3 trials asked if clinicians would recommend the decision aid to colleagues and only 5 asked if clinicians would use decision aids in the future. Outpatient consultations were not prolonged when a decision aid was used in 9 out of 13 trials. The overall strength of the evidence was low, with the major risk of bias related to lack of blinding of participants and/or outcome assessors. Decision aids can improve clinicians’ satisfaction with medical decision making and provide helpful information without affecting length of consultation time. Most shared decision making trials, however, omit outcomes related to clinicians’ perspective on the decision making process or the likelihood of using a decision aid in the future.
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影响因子：
9.7
作者：
Legare, France;Witteman, Holly O.
通讯作者：
Witteman, Holly O.
影响因子：
2.9
作者：
Mathers N;Ng CJ;Campbell MJ;Colwell B;Brown I;Bradley A
通讯作者：
Bradley A
基于互联网的培训对急性呼吸道感染的抗生素处方率的影响：跨国，群集，随机，阶乘，对照试验。
影响因子：
168.9
作者：
Little, Paul;Stuart, Beth;Francis, Nick;Douglas, Elaine;Tonkin-Crine, Sarah;Anthierens, Sibyl;Cals, Jochen W. L.;Melbye, Hasse;Santer, Miriam;Moore, Michael;Coenen, Samuel;Butler, Chris;Hood, Kerenza;Kelly, Mark;Godycki-Cwirko, Maciek;Mierzecki, Artur;Torres, Antoni;Llor, Carl;Davies, Melanie;Mullee, Mark;O'Reilly, Gilly;van der Velden, Alike;Geraghty, Adam W. A.;Goossens, Herman;Verheij, Theo;Yardley, Lucy
通讯作者：
Yardley, Lucy
影响因子：
2.4
作者：
Elwyn, Glyn;Rasmussen, Julie;Wood, Fiona
通讯作者：
Wood, Fiona
影响因子：
45.3
作者：
Leighl, Natasha B.;Shepherd, Heather L.;Tattersall, Martin H. N.
通讯作者：
Tattersall, Martin H. N.