Herrmann Anne, Mansfield Elise, Hall Alix E, Sanson-Fisher Rob, Zdenkowski Nicholas
Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle and Hunter Medical Research Institute, W4, HMRI Building, University Drive, Callaghan, NSW, Australia.
Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia.
BMC Med Inform Decis Mak. 2016 Mar 15;16:36. doi: 10.1186/s12911-016-0273-8.
There is evidence to suggest that decision aids improve a number of patient outcomes. However, little is known about the progression of research effort in this area over time. This literature review examined the volume of research published in 2000, 2007 and 2014 which tested the effectiveness of decision aids in improving cancer patient outcomes, coded by cancer site and decision type being targeted. These numbers were compared with the volume of research examining the effectiveness of strategies to increase the adoption of decision aids by healthcare providers.
A literature review of intervention studies was undertaken. Medline, Embase, PsychInfo and Cochrane Database of Systematic Reviews were searched. The search was limited to human studies published in English, French, or German. Abstracts were assessed against eligibility criteria by one reviewer and a random sample of 20 % checked by a second. Eligible intervention studies in the three time periods were categorised by: i) whether they tested the effectiveness of decision aids, coded by cancer site and decision type, and ii) whether they tested strategies to increase healthcare provider adoption of decision aids.
Over the three time points assessed, increasing research effort has been directed towards testing the effectiveness of decision aids in improving patient outcomes (p < 0.0001). The number of studies on decision aids for cancer screening or prevention increased statistically significantly (p < 0.0001) whereas the number of studies on cancer treatment did not (p = 1.00). The majority of studies examined the effectiveness of decision aids for prostate (n = 10), breast (n = 9) or colon cancer (n = 7). Only two studies assessed the effectiveness of implementation strategies to increase healthcare provider adoption of decision aids.
While the number of studies testing the effectiveness of decision aids has increased, the majority of research has focused on screening and prevention decision aids for only a few cancer sites. This neglects a number of cancer populations, as well as other areas of cancer care such as treatment decisions. Also, given the apparent effectiveness of decision aids, more effort needs to be made to implement this evidence into meaningful benefits for patients.
有证据表明决策辅助工具可改善多项患者预后。然而，对于该领域研究工作随时间的进展情况却知之甚少。本综述考察了2000年、2007年和2014年发表的研究数量，这些研究测试了决策辅助工具在改善癌症患者预后方面的有效性，并按所针对的癌症部位和决策类型进行编码。将这些数字与考察提高医疗服务提供者采用决策辅助工具策略有效性的研究数量进行比较。
对干预研究进行综述。检索了Medline、Embase、PsychInfo和Cochrane系统评价数据库。检索限于以英文、法文或德文发表的人体研究。由一名评审员根据纳入标准评估摘要，随机抽取20%由第二名评审员进行核对。三个时间段内符合条件的干预研究按以下方式分类：i）是否测试了决策辅助工具的有效性，按癌症部位和决策类型编码；ii）是否测试了提高医疗服务提供者采用决策辅助工具的策略。
在评估的三个时间点上，针对测试决策辅助工具在改善患者预后方面有效性的研究工作不断增加（p < 0.0001）。关于癌症筛查或预防决策辅助工具的研究数量有统计学显著增加（p < 0.0001），而关于癌症治疗的研究数量则无增加（p = 1.00）。大多数研究考察了前列腺癌（n = 10）、乳腺癌（n = 9）或结肠癌（n = 7）决策辅助工具的有效性。仅有两项研究评估了提高医疗服务提供者采用决策辅助工具的实施策略的有效性。
虽然测试决策辅助工具有效性的研究数量有所增加，但大多数研究仅关注少数癌症部位的筛查和预防决策辅助工具。这忽视了许多癌症人群以及癌症护理的其他领域，如治疗决策。此外，鉴于决策辅助工具的明显有效性，需要做出更多努力将这一证据转化为对患者有意义的益处。
