O'Connor Annette M, Bennett Carol, Stacey Dawn, Barry Michael J, Col Nananda F, Eden Karen B, Entwistle Vikki, Fiset Valerie, Holmes-Rovner Margaret, Khangura Sara, Llewellyn-Thomas Hilary, Rovner David R
Ottawa Health Research Institute, Canada.
Med Decis Making. 2007 Sep-Oct;27(5):554-74. doi: 10.1177/0272989X07307319. Epub 2007 Sep 14.
To describe the extent to which patient decision aids (PtDAs) meet effectiveness standards of the International Patient Decision Aids Collaboration (IPDAS).
Five electronic databases (to July 2006) and personal contacts (to December 2006).
Among 55 randomized controlled trials, 38 (69%) used at least 1 measure that mapped onto an IPDAS effectiveness criterion. Measures of decision quality were knowledge scores (27 trials), accurate risk perceptions (12 trials), and value congruence with the chosen option (3 trials). PtDAs improved knowledge scores relative to usual care (weighted mean difference [WMD] = 15.2%, 95% confidence interval [CI] = 11.7 to 18.7); detailed PtDAs were somewhat more effective than simpler PtDAs (WMD = 4.6%, 95% CI = 3.0 to 6.2). PtDAs with probabilities improved accurate risk perceptions relative to those without probabilities (relative risk = 1.6, 95% CI = 1.4 to 1.9). Relative to simpler PtDAs, detailed PtDAs improved value congruence with the chosen option. Only 2 of 6 IPDAS decision process criteria were measured: feeling informed (15 trials) and feeling clear about values (13 trials). PtDAs improved these process measures relative to usual care (feeling uninformed WMD = -8.4, 95% CI = -11.9 to -4.8; unclear values WMD = -6.3, 95% CI = -10.0 to -2.7). There was no difference in process measures when detailed and simple PtDAs were compared.
PtDAs improve decision quality and the decision process's measures of feeling informed and clear about values; however, the size of the effect varies across studies. Several IPDAS decision process measures have not been used. Future trials need to use a minimum data set of IPDAS evaluation measures. The degree of detail PtDAs require for positive effects on IPDAS criteria should be explored.
描述患者决策辅助工具（PtDAs）达到国际患者决策辅助工具协作组织（IPDAS）有效性标准的程度。
五个电子数据库（截至2006年7月）和个人联系人（截至2006年12月）。
在55项随机对照试验中，38项（69%）使用了至少一项符合IPDAS有效性标准的测量方法。决策质量的测量指标包括知识得分（27项试验）、准确的风险认知（12项试验）以及与所选选项的价值一致性（3项试验）。与常规护理相比，PtDAs提高了知识得分（加权平均差[WMD]=15.2%，95%置信区间[CI]=11.7至18.7）；详细的PtDAs比简单的PtDAs稍有效（WMD=4.6%，95%CI=3.0至6.2）。与没有概率信息的PtDAs相比，有概率信息的PtDAs提高了准确的风险认知（相对风险=1.6，95%CI=1.4至1.9）。与简单的PtDAs相比，详细的PtDAs提高了与所选选项的价值一致性。在IPDAS决策过程标准的6项中，仅测量了2项：感觉信息充分（15项试验）和感觉价值观清晰（13项试验）。与常规护理相比，PtDAs改善了这些过程测量指标（感觉信息不充分WMD=-8.4，95%CI=-11.9至-4.8；价值观不清晰WMD=-6.3，95%CI=-10.0至-2.7）。比较详细的和简单的PtDAs时，过程测量指标没有差异。
PtDAs提高了决策质量以及感觉信息充分和价值观清晰的决策过程测量指标；然而，不同研究中效果的大小有所不同。IPDAS的几项决策过程测量方法尚未使用。未来的试验需要使用IPDAS评估测量方法的最小数据集。应探索PtDAs对IPDAS标准产生积极影响所需的详细程度。
