Gagliardi Anna R, Légaré France, Brouwers Melissa C, Webster Fiona, Badley Elizabeth, Straus Sharon
University Health Network, Toronto, Canada.
Université Laval, Quebec City, Canada.
Implement Sci. 2016 Feb 29;11:26. doi: 10.1186/s13012-016-0389-3.
Patient-mediated knowledge translation (PKT) interventions engage patients in their own health care. Insight on which PKT interventions are effective is lacking. We sought to describe the type and impact of PKT interventions.
We performed a systematic review of PKT interventions, defined as strategies that inform, educate and engage patients in their own health care. We searched MEDLINE, EMBASE and the Cochrane Library from 2005 to 2014 for English language studies that evaluated PKT interventions delivered immediately before, during or upon conclusion of clinical encounters to individual patients with arthritis or cancer. Data were extracted on study characteristics, PKT intervention (theory, content, delivery, duration, personnel, timing) and outcomes. Interventions were characterized by type of patient engagement (inform, activate, collaborate). We performed content analysis and reported summary statistics.
Of 694 retrieved studies, 16 were deemed eligible (5 arthritis, 11 cancer; 12 RCTs, 4 cohort studies; 7 low, 3 uncertain, 6 high risk of bias). PKT interventions included print material in 10 studies (brochures, booklets, variety of print material, list of websites), electronic material in 10 studies (video, computer program, website) and counselling in 2 studies. They were offered before, during and after consultation in 4, 1 and 4 studies, respectively; as single or multifaceted interventions in 10 and 6 studies, respectively; and by clinicians, health educators, researchers or volunteers in 4, 3, 5 and 1 study, respectively. Most interventions informed or activated patients. All studies achieved positive impact in one or more measures of patient knowledge, decision-making, communication and behaviour. This was true regardless of condition, PKT intervention, timing, personnel, type of engagement or delivery (single or multifaceted). No studies assessed patient harms, or interventions for providers to support PKT intervention delivery. Two studies evaluated the impact on providers of PKT interventions aimed at patients.
Single interventions involving print material achieved beneficial outcomes as did more complex interventions. Few studies were eligible, and no studies evaluated patient harms, or provider outcomes. Further research is warranted to evaluate these PKT interventions in more patients, or patients with different conditions; different types of PKT interventions for patients and for providers; and potential harms associated with interventions.
患者介导的知识转化（PKT）干预措施让患者参与自身的医疗保健。目前缺乏关于哪些PKT干预措施有效的见解。我们试图描述PKT干预措施的类型和影响。
我们对PKT干预措施进行了系统评价，PKT干预措施定义为在患者自身医疗保健中为其提供信息、教育并使其参与的策略。我们检索了2005年至2014年期间的MEDLINE、EMBASE和Cochrane图书馆，查找以英文发表的研究，这些研究评估了在临床诊疗前、诊疗期间或诊疗结束时为关节炎或癌症个体患者提供的PKT干预措施。提取了关于研究特征、PKT干预措施（理论、内容、实施方式、持续时间、人员、时机）和结果的数据。干预措施根据患者参与类型（提供信息、促使行动、协作）进行分类。我们进行了内容分析并报告了汇总统计数据。
在检索到的694项研究中，16项被认为符合条件（5项关于关节炎，11项关于癌症；12项随机对照试验，4项队列研究；7项低偏倚风险，3项不确定偏倚风险，6项高偏倚风险）。PKT干预措施包括10项研究中的印刷材料（手册、小册子、各种印刷材料、网站列表），10项研究中的电子材料（视频、计算机程序、网站）以及2项研究中的咨询服务。分别在4项、1项和4项研究中于咨询前、咨询期间和咨询后提供；分别在10项和6项研究中作为单一或多方面干预措施；分别由临床医生、健康教育工作者、研究人员或志愿者在4项、3项、5项和1项研究中提供。大多数干预措施为患者提供了信息或促使其采取行动。所有研究在患者知识、决策、沟通和行为的一项或多项指标上都取得了积极影响。无论疾病状况、PKT干预措施、时机、人员、参与类型或实施方式（单一或多方面）如何，都是如此。没有研究评估患者的不良影响，也没有评估支持PKT干预措施实施的针对提供者的干预措施。两项研究评估了针对患者的PKT干预措施对提供者的影响。
涉及印刷材料的单一干预措施与更复杂的干预措施一样取得了有益的结果。符合条件的研究很少，没有研究评估患者的不良影响或提供者的结果。有必要进行进一步研究，以评估更多患者或不同疾病患者中的这些PKT干预措施；针对患者和提供者的不同类型的PKT干预措施；以及与干预措施相关的潜在不良影响。
