Do patient decision aids meet effectiveness Criteria of the international patient decision aid standards collaboration? A systematic review and meta-analysis
Do patient decision aids meet effectiveness Criteria of the international patient decision aid standards collaboration? A systematic review and meta-analysis
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DOI：
10.1177/0272989x07307319
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发表时间：
2007-09-01
影响因子：
3.6
通讯作者：
Rovner, David R.
中科院分区：
文献类型：
--
作者：
O'Connor, Annette M.;Bennett, Carol;Rovner, David R.
目标。描述患者决策辅助（PtDAs）达到国际患者决策辅助协作（IPDAS）有效性标准的程度。数据源。五个电子资料库（至2006年7月）及个人联络（至2006年12月）。结果。在55项随机对照试验中，38项（69%）使用了至少1项与IPDAS有效性标准相对应的测量方法。决策质量的测量是知识得分（27项试验），准确的风险感知（12项试验）和与所选选项的价值一致性（3项试验）。相对于常规护理，ptda提高了知识得分（加权平均差[WMD] = 15.2%， 95%可信区间[CI] = 11.7 ~ 18.7）；详细的ptda比简单的ptda更有效（WMD = 4.6%, 95% CI= 3.0 ~ 6.2）。相对于没有概率的ptda，有概率的ptda提高了准确的风险感知（相对风险= 1.6,95% CI = 1.4至1.9）。相对于更简单的ptda，详细的ptda改进了与所选选项的值一致性。6项IPDAS决策过程标准中只有2项被测量：感觉知情（15项试验）和感觉对价值观清晰（13项试验）。相对于常规护理，ptda改善了这些过程测量（感觉不知情的WMD = -8.4, 95% GI = -11.9至-4.8；不清楚的WMD = -6.3, 95% CI = -10.0至-2.7）。当详细的和简单的ptda进行比较时，过程测量没有差异。结论。ptda提高了决策质量和决策过程中对价值观的知情感和清晰感的度量；然而，影响的大小在不同的研究中有所不同。IPDAS的几个决策过程措施没有使用。未来的试验需要使用IPDAS评估措施的最小数据集，应该探索PtDAs对IPDAS标准的积极影响所需的详细程度。
Objective. To describe the extent to which patient decision aids (PtDAs) meet effectiveness standards of the International Patient Decision Aids Collaboration (IPDAS). Data sources. Five electronic databases (to July 2006) and personal contacts (to December 2006). Results. Among 55 randomized controlled trials, 38 (69%) used at least 1 measure that mapped onto an IPDAS effectiveness criterion. Measures of decision quality were knowledge scores (27 trials), accurate risk perceptions (12 trials), and value congruence with the chosen option (3 trials). PtDAs improved knowledge scores relative to usual care (weighted mean difference [WMD] = 15.2%, 95% confidence interval [CI] = 11.7 to 18.7); detailed PtDAs were somewhat more effective than simpler PtDAs (WMD = 4.6%, 95% CI= 3.0 to 6.2). PtDAs with probabilities improved accurate risk perceptions relative to those without probabilities (relative risk = 1.6, 95% CI = 1.4 to 1.9). Relative to simpler PtDAs, detailed PtDAs improved value congruence with the chosen option. Only 2 of 6 IPDAS decision process criteria were measured: feeling informed (15 trials) and feeling clear about values (13 trials). PtDAs improved these process measures relative to usual care (feeling uninformed WMD = -8.4, 95 % GI = -11.9 to -4.8; unclear values WMD = -6.3, 95 % CI = -10.0 to -2.7). There was no difference in process measures when detailed and simple PtDAs were compared. Conclusions. PtDAs improve decision quality and the decision process's measures of feeling informed and clear about values; however, the size of the effect varies across studies. Several IPDAS decision process measures have not been used. Future trials need to use a minimum data set of IPDAS evaluation measures, The degree of detail PtDAs require for positive effects on IPDAS criteria should be explored.