Informed decision making: What is its role in cancer screening?
Informed decision making: What is its role in cancer screening?
复制标题
DOI：
10.1002/cncr.20512
复制
发表时间：
2004-09-01
期刊：
影响因子：
6.2
通讯作者：
Woolf, SH
中科院分区：
文献类型：
--
作者：
Rimer, BK;Briss, PA;Woolf, SH
近年来，人们对知情决策(IDM)的兴趣有所增加。患者更多地参与决策与提高医疗质量的建议是一致的。这份报告提供了IDM的概述；澄清了IDM、共享决策(SDM)和知情同意之间的区别；并回顾了迄今为止关于IDM用于癌症筛查的证据。作者还对研究提出了建议。我们将IDM定义为：当个人了解正在处理的疾病或情况，并了解临床服务涉及的内容，包括其好处、风险、限制、替代方案和不确定性；考虑了他或她的偏好并做出与他们一致的决定；并相信他或她参与了所需级别的决策。IDM干预措施用于促进知情决策。作者回顾了迄今为止IDM和癌症筛查的证据，主要基于发表的荟萃分析和疾病控制和预防中心的社区预防服务指南最近的一份报告。IDM和SDM干预措施，如决策辅助工具，可改善知识、信念、风险认知以及这些因素的组合。然而，很少或根本没有证据表明，这些干预措施是否导致1)参与决策的程度与患者的偏好一致，或者2)影响患者对决策过程的满意度。这些变量通常要么没有被评估，要么没有在所审查的文章中报告。对筛查摄取的干预结果是不同的。在接触IDM/SDM干预措施后，大多数研究显示前列腺癌筛查略有下降，而四项关于乳腺癌和结直肠癌筛查的研究显示小幅增加。几乎没有数据可以用来评估目前在癌症筛查IDM中的做法。对于那些喜欢IDM的人，应该促进患者参与IDM。需要进行更多的研究，以评估IDM/SDM干预措施的益处，并为最有可能希望并从中受益的个人量身定制干预措施。IDM/SDM的系统障碍很多，工具很少。在这方面也需要做更多的工作。此外，还需要进行研究，以了解如何将IDM纳入正在进行的临床实践中，并确定IDM是否存在意想不到的负面后果。(C)2004年美国癌症协会。
Interest in informed decision making (IDM) has grown in recent years. Greater patient involvement in decision making is consistent with recommendations to improve health care quality. This report provides an overview of IDM; clarifies the differences between IDM, shared decision making (SDM), and informed consent; and reviews the evidence to date about IDM for cancer screening. The authors also make recommendations for research. We define IDM as occurring when an individual understands the disease or condition being addressed and comprehends what the clinical service involves, including its benefits, risks, limitations, alternatives, and uncertainties; has considered his or her preferences and makes a decision consistent with them; and believes he or she has participated in decision making at the level desired. IDM interventions are used to facilitate informed decisions. The authors reviewed the evidence to date for IDM and cancer screening based primarily on published meta-analyses and a recent report for the Centers for Disease Control and Prevention's Guide to Community Preventive Services. IDM and SDM interventions, such as decision aids, result in improved knowledge, beliefs, risk perceptions, and combinations of these. Little or no evidence exists, however, regarding whether these interventions result in 1) participation in decision making at a level consistent with patient preferences or 2) effects on patient satisfaction with the decision-making process. These variables generally either were not assessed or were not reported in the articles reviewed. Results of interventions on uptake of screening were variable. After exposure to IDM/SDM interventions, most studies showed small decreases in prostate cancer screening, whereas four studies on breast and colorectal cancer screening showed small increases. Few data are available by which to evaluate current practices in cancer screening IDM. Patient participation in IDM should be facilitated for those who prefer it. More research is needed to assess the benefits of IDM/SDM interventions and to tailor interventions to individuals who are most likely to desire and benefit from them. There are many system barriers to IDM/SDM and few tools. More work is needed in this area as well. In addition, research is needed to learn how to incorporate IDM into ongoing clinical practice and to determine whether there are unintended negative consequences of IDM. (C) 2004 American Cancer Society.