O'Connor A M, Rostom A, Fiset V, Tetroe J, Entwistle V, Llewellyn-Thomas H, Holmes-Rovner M, Barry M, Jones J
University of Ottawa School of Nursing and Faculty of Medicine, Loeb Health Research Institute, Clinical Epidemiology Unit, Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada K1Y 4E9.
BMJ. 1999 Sep 18;319(7212):731-4. doi: 10.1136/bmj.319.7212.731.
To conduct a systematic review of randomised trials of patient decision aids in improving decision making and outcomes.
We included randomised trials of interventions providing structured, detailed, and specific information on treatment or screening options and outcomes to aid decision making. Two reviewers independently screened and extracted data on several evaluation criteria. Results were pooled by using weighted mean differences and relative risks.
17 studies met the inclusion criteria. Compared with the controls, decision aids produced higher knowledge scores (weighted mean difference=19/100, 95% confidence interval 14 to 25); lower decisional conflict scores (weighted mean difference=-0.3/5, -0.4 to -0.1); more active patient participation in decision making (relative risk = 2.27, 95% confidence interval 1. 3 to 4); and no differences in anxiety, satisfaction with decisions (weighted mean difference=0.6/100, -3 to 4), or satisfaction with the decision making process (2/100,-3 to 7). Decision aids had a variable effect on decisions. When complex decision aids were compared with simpler versions, they were better at reducing decisional conflict, improved knowledge marginally, but did not affect satisfaction.
Decision aids improve knowledge, reduce decisional conflict, and stimulate patients to be more active in decision making without increasing their anxiety. Decision aids have little effect on satisfaction and a variable effect on decisions. The effects on outcomes of decisions (persistence with choice, quality of life) remain uncertain.
对患者决策辅助工具在改善决策制定和结果方面的随机试验进行系统评价。
我们纳入了提供有关治疗或筛查选择及结果的结构化、详细且具体信息以辅助决策的干预措施的随机试验。两名评审员独立筛选并提取了关于多个评估标准的数据。结果采用加权平均差和相对风险进行汇总。
17项研究符合纳入标准。与对照组相比，决策辅助工具产生了更高的知识得分（加权平均差 = 19/100，95%置信区间14至25）；更低的决策冲突得分（加权平均差 = -0.3/5，-0.4至 -0.1）；患者在决策制定中更积极参与（相对风险 = 2.27，95%置信区间1.3至4）；并且在焦虑、对决策的满意度（加权平均差 = 0.6/100，-3至4）或对决策过程的满意度（2/100，-3至7）方面没有差异。决策辅助工具对决策有不同的影响。当将复杂的决策辅助工具与更简单的版本进行比较时，它们在减少决策冲突方面表现更好，对知识的改善略有提升，但不影响满意度。
决策辅助工具可提高知识水平，减少决策冲突，并促使患者在决策制定中更积极主动，同时不会增加他们的焦虑。决策辅助工具对满意度影响不大，对决策有不同的影响。对决策结果（坚持选择、生活质量）的影响仍不确定。
