BMC Med Inform Decis Mak. 2013;13 Suppl 2(Suppl 2):S14. doi: 10.1186/1472-6947-13-S2-S14. Epub 2013 Nov 29.
Two decades of research has established the positive effect of using patient-targeted decision support interventions: patients gain knowledge, greater understanding of probabilities and increased confidence in decisions. Yet, despite their efficacy, the effectiveness of these decision support interventions in routine practice has yet to be established; widespread adoption has not occurred. The aim of this review was to search for and analyze the findings of published peer-reviewed studies that investigated the success levels of strategies or methods where attempts were made to implement patient-targeted decision support interventions into routine clinical settings.
An electronic search strategy was devised and adapted for the following databases: ASSIA, CINAHL, Embase, HMIC, Medline, Medline-in-process, OpenSIGLE, PsycINFO, Scopus, Social Services Abstracts, and the Web of Science. In addition, we used snowballing techniques. Studies were included after dual independent assessment.
After assessment, 5322 abstracts yielded 51 articles for consideration. After examining full-texts, 17 studies were included and subjected to data extraction. The approach used in all studies was one where clinicians and their staff used a referral model, asking eligible patients to use decision support. The results point to significant challenges to the implementation of patient decision support using this model, including indifference on the part of health care professionals. This indifference stemmed from a reported lack of confidence in the content of decision support interventions and concern about disruption to established workflows, ultimately contributing to organizational inertia regarding their adoption.
It seems too early to make firm recommendations about how best to implement patient decision support into routine practice because approaches that use a 'referral model' consistently report difficulties. We sense that the underlying issues that militate against the use of patient decision support and, more generally, limit the adoption of shared decision making, are under-investigated and under-specified. Future reports from implementation studies could be improved by following guidelines, for example the SQUIRE proposals, and by adopting methods that would be able to go beyond the 'barriers' and 'facilitators' approach to understand more about the nature of professional and organizational resistance to these tools. The lack of incentives that reward the use of these interventions needs to be considered as a significant impediment.
二十年的研究已经确立了使用以患者为目标的决策支持干预措施的积极效果：患者获得知识，对概率的理解加深，对决策的信心增强。然而，尽管这些决策支持干预措施具有疗效，但尚未在常规实践中确定其有效性；它们尚未被广泛采用。本研究的目的是搜索和分析已发表的同行评议研究的结果，这些研究调查了尝试将以患者为目标的决策支持干预措施应用于常规临床环境的策略或方法的成功水平。
设计并改编了一个电子搜索策略，用于以下数据库：ASSIA、CINAHL、Embase、HMIC、Medline、Medline-in-process、OpenSIGLE、PsycINFO、Scopus、Social Services Abstracts 和 Web of Science。此外，我们还使用了滚雪球技术。经过双重独立评估，对 5322 篇摘要进行了评估，得出 51 篇文章以供考虑。在检查全文后，纳入了 17 项研究并进行了数据提取。所有研究都采用了一种方法，即临床医生及其工作人员使用转诊模式，要求符合条件的患者使用决策支持。结果表明，使用这种模式实施患者决策支持存在重大挑战，包括医疗保健专业人员的漠不关心。这种漠不关心源于对决策支持干预内容缺乏信心，并担心会破坏既定的工作流程，最终导致对其采用的组织惰性。
现在就如何将患者决策支持最佳地应用于常规实践提出明确建议还为时过早，因为使用“转诊模式”的方法一致报告存在困难。我们感觉，不利于使用患者决策支持以及更广泛地限制采用共享决策的根本问题没有得到充分调查和具体说明。实施研究的未来报告可以通过遵循指南（例如 SQUIRE 提案）和采用能够超越“障碍”和“促进因素”方法的方法来加以改进，以更好地了解专业人员和组织对这些工具的抵制的性质。需要考虑缺乏奖励使用这些干预措施的激励措施，这是一个重大障碍。
