Examining Interventions Designed to Support Shared Decision Making and Subsequent Patient Outcomes in Palliative Care: A Systematic Review of the Literature.
Examining Interventions Designed to Support Shared Decision Making and Subsequent Patient Outcomes in Palliative Care: A Systematic Review of the Literature.
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DOI：
10.1177/1049909118783688
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发表时间：
2019-01
期刊：
影响因子：
--
通讯作者：
Masterson Creber RM
中科院分区：
文献类型：
--
作者：
Baik D;Cho H;Masterson Creber RM
共享决策（SDM）是以患者为中心的护理的一个关键属性，它使姑息治疗患者能够根据自己的价值观和偏好做出关于临终治疗的最佳医疗决策。本系统性文献综述的目的是详细介绍和比较过去10年（2008年1月至2017年12月）支持SDM的干预措施，并分析患者/护理人员在生命结束时的结局。本综述遵循系统性综述和荟萃分析的首选报告项目指南。使用关键检索词：SDM、决策辅助、决策支持、姑息治疗和临终关怀，检索PubMed、CINAHL、Embase和科克伦图书馆。采用混合方法评价工具评价纳入研究的质量。初步检索得到2705篇文章，12项研究被纳入最终综述。研究的质量一般，技术支持的交付模式（例如，视频、DVD、基于网络的工具）是最常用的。患者/护理人员对临终关怀的了解是各项研究中最常见的主要结局。SDM干预与患者/护理者结果之间的关联强度各不相同。研究SDM干预对患者结局的影响的研究结果不一致，突出表明需要使用一致的措施在不同的患者人群中进行进一步的SDM干预研究。鉴于卫生技术的可用性，未来的研究应侧重于开发个性化的，技术支持的干预措施，以支持以患者为中心的医疗决策。
Shared decision making (SDM) is a key attribute of patient-centered care, which empowers palliative care patients to be able to make optimal medical decisions about end-of-life treatments based on their own values and preferences. The aim of this systematic literature review is to detail and compare interventions supporting SDM over the last 10 years (January 2008 to December 2017) and to analyze patient/caregiver outcomes at the end of life. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, Embase, and Cochrane Library were searched with key search terms: SDM, decision aid, decision support, palliative care, and hospice care. The Mixed Methods Appraisal Tool was used to assess the quality of the included studies. The initial search yielded 2705 articles, and 12 studies were included in the final review. The quality of the studies was modest and technology-enabled delivery modes (e.g., video, DVD, web-based tool) were most commonly used. Patient/caregiver knowledge of end-of-life care was the most common primary outcome across studies. The strength of the association between the SDM interventions and patient/caregiver outcomes varied. The findings from the studies that examined the effects of the SDM intervention on patient outcomes were inconsistent, highlighting the need for further SDM intervention studies among diverse patient populations using consistent measures. Given the availability of health technologies, future studies should focus on developing individual-tailored, technology-enabled interventions to support patient-centered medical decision making.
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