Barry Michael J
Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Ann Intern Med. 2002 Jan 15;136(2):127-35. doi: 10.7326/0003-4819-136-2-200201150-00010.
For medical decisions with more than one reasonable option, patient participation in decision making is often necessary to optimally match management decisions with patient preferences. Health decision aids are designed to facilitate shared decision making by helping patients and their physicians choose among reasonable clinical options. Although these aids vary in content, common denominators are the presentation of more than one reasonable strategy for a clinical management question and a description of the possible outcomes of the various options. Although the number of published randomized trials assessing the impact of health decision aids on the quality of medical decisions is limited (but growing), various types of decision aids do generally appear to inform patients about their treatment options better than "usual care" can. Little evidence is available to determine whether one type of decision aid is optimal, but more complicated programs seem to have larger effects. The cost-effectiveness of decision aids has not been studied, although it is enticing to think that the pattern of more conservative decisions by users of some decision aids could reduce medical care costs in a manner that is dictated by patient preferences.
对于存在多种合理选择的医疗决策而言，患者参与决策往往是必要的，以便使管理决策与患者偏好实现最佳匹配。健康决策辅助工具旨在通过帮助患者及其医生在合理的临床选项中进行选择，促进共同决策。尽管这些辅助工具在内容上有所不同，但共同之处在于针对临床管理问题呈现不止一种合理策略，并描述各种选项可能的结果。虽然评估健康决策辅助工具对医疗决策质量影响的已发表随机试验数量有限（但在增加），但各类决策辅助工具通常似乎比“常规护理”能更好地让患者了解其治疗选择。几乎没有证据可确定哪种类型的决策辅助工具是最佳的，但更复杂的程序似乎效果更大。决策辅助工具的成本效益尚未得到研究，不过，认为一些决策辅助工具的使用者做出更保守决策的模式能够以患者偏好所决定的方式降低医疗成本，这一想法很有吸引力。
