Bereza Basil G, Troelsgaard Nielsen Anders, Valgardsson Sverrir, Hemels Michiel E H, Einarson Thomas R
Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada.
Janssen A/S, Birkerød, Denmark.
Int J Chron Obstruct Pulmon Dis. 2015 Apr 8;10:739-44. doi: 10.2147/COPD.S82179. eCollection 2015.
Management of chronic incurable diseases such as chronic obstructive pulmonary disease (COPD) and asthma is difficult. Incorporation of patient preferences is widely encouraged.
To summarize original research articles determining patient preference in moderate-to-severe disease.
Acceptable articles consisted of original research determining preferences for any aspect of care in patients with COPD/asthma. The target population included those with severe disease; however, articles were accepted if they separated outcomes by severity or if the majority had at least moderate-to-severe disease. We also accepted simulation research based on scenarios describing situations involving moderate-to-severe disease that elicited preferences. Two reviewers searched Medline and Embase for articles published from the date of inception of the databases until the end of November 2014, with differences resolved through consensus discussion. Data were tabulated and analyzed descriptively.
About 478 articles identified, 448 were rejected and 30 analyzed. There were 25 on COPD and five on asthma. Themes identified as most important in COPD were symptom relief (dyspnea/breathlessness), a positive patient-physician relationship, quality-of-life impairments, and information availability. Patients strongly preferred sponsors' inhalers. At end-of-life, 69% preferred receiving CPR, 70% wanted noninvasive, and 58% invasive mechanical intervention. While patients with asthma preferred treatments that increased symptom-free days, they were willing to trade days without symptoms for a reduction in adverse events and greater convenience. Asthma patients were willing to pay for waking up once and not needing their inhaler over waking up once overnight and needing their inhaler.
Few studies have examined patient preference in these diseases. More research is needed to fill in knowledge gaps.
慢性阻塞性肺疾病（COPD）和哮喘等慢性不治之症的管理难度较大。目前广泛鼓励将患者偏好纳入考量。
总结确定中重度疾病患者偏好的原创研究文章。
纳入的合格文章包括确定COPD/哮喘患者对护理任何方面偏好的原创研究。目标人群包括重症患者；然而，如果文章按严重程度区分结果，或者大多数患者至少患有中重度疾病，则这些文章也可被接受。我们还接受基于描述涉及中重度疾病情况并引发偏好的情景模拟研究。两名评审员检索了Medline和Embase数据库，查找从数据库创建之日至2014年11月底发表的文章，通过共识讨论解决分歧。数据制成表格并进行描述性分析。
共识别出约478篇文章，448篇被拒，30篇进行了分析。其中25篇关于COPD，5篇关于哮喘。在COPD中被确定为最重要的主题是症状缓解（呼吸困难/气促）良好的医患关系、生活质量受损和信息可得性。患者强烈偏好赞助商提供的吸入器。在生命末期，69%的患者倾向于接受心肺复苏，70%希望接受无创治疗，58%希望接受有创机械干预。虽然哮喘患者更喜欢能增加无症状天数的治疗方法，但他们愿意用无症状天数来换取不良事件减少和更大的便利性。哮喘患者愿意为醒来一次且无需使用吸入器付费，而不愿醒来一次且夜间需要使用吸入器。
很少有研究考察这些疾病患者的偏好。需要更多研究来填补知识空白。
