Haywood Kirstie, Marshall Susan, Fitzpatrick Ray
Royal College of Nursing Institute, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, UK.
Patient Educ Couns. 2006 Oct;63(1-2):12-23. doi: 10.1016/j.pec.2005.10.005. Epub 2006 Jan 6.
To describe the range and effectiveness of intervention strategies designed to enhance patient participation in the consultation process.
A systematic review of published literature (1976-2004) was undertaken. Controlled trials in English were included. Data regarding study design, intervention characteristics, patient populations and study results were extracted.
One hundred and forty-six articles describing 137 trials were reviewed. A pragmatic categorisation of intervention strategies and study outcomes supported data synthesis. Patient-targeted coaching and educational materials, and provider-targeted communication skills training have a substantial impact on communication. Information feedback to providers from patient-reported outcome measures (PROMs) benefits provider diagnosis and management of patient conditions. Communication and provider diagnosis and management benefit most from the reviewed interventions. Although patient satisfaction and health status were two of the most frequently measured outcomes, overall, the interventions appeared to have less impact on patient self-efficacy, attitudes and behaviours, patient satisfaction, health status and resource use.
Evidence is insufficient to strongly advocate one approach to enhancing patient participation in the consultation process. More rigorous research design with clearly specified intervention strategies and appropriately defined outcomes assessed over both the short and long term is required.
Although limited and inconclusive, the most extensive and most encouraging evidence to enhance patient participation in the consultation process is available for three patient-targeted intervention strategies (coaching, educational materials and PROMs feedback to providers) and one provider-targeted intervention strategy (communication skills training).
描述旨在提高患者在会诊过程中参与度的干预策略的范围和效果。
对已发表文献（1976 - 2004年）进行系统综述。纳入英文对照试验。提取有关研究设计、干预特征、患者群体和研究结果的数据。
对描述137项试验的146篇文章进行了综述。对干预策略和研究结果进行务实分类有助于数据综合。以患者为目标的指导和教育材料，以及以提供者为目标的沟通技能培训对沟通有重大影响。患者报告结局测量（PROMs）向提供者提供的信息反馈有利于提供者对患者病情的诊断和管理。沟通以及提供者的诊断和管理从所综述的干预措施中获益最大。尽管患者满意度和健康状况是最常测量的两项结局，但总体而言，这些干预措施似乎对患者自我效能、态度和行为、患者满意度、健康状况及资源利用的影响较小。
证据不足以强烈主张采用一种方法来提高患者在会诊过程中的参与度。需要更严谨的研究设计，明确规定干预策略，并对短期和长期的适当定义结局进行评估。
尽管有限且尚无定论，但关于提高患者在会诊过程中参与度的最广泛且最令人鼓舞的证据可用于三种以患者为目标的干预策略（指导、教育材料以及向提供者反馈PROMs）和一种以提供者为目标的干预策略（沟通技能培训）。
