Cardona-Morrell Magnolia, Benfatti-Olivato Gustavo, Jansen Jesse, Turner Robin M, Fajardo-Pulido Diana, Hillman Ken
South Western Sydney Clinical School and Ingham Institute for Applied Medical Research, The University of New South Wales, Sydney, Australia.
Faculty of Medicine, The University of New South Wales, Australia and Botucatu Medical School, Sao Paulo State University, Botucatu, Brazil.
Patient Educ Couns. 2017 Mar;100(3):425-435. doi: 10.1016/j.pec.2016.10.007. Epub 2016 Oct 11.
To describe the range of decision aids (DAs) available to enable informed choice for older patients at the end of life and assess their effectiveness or acceptability.
Search strategy covered PubMed, Scopus, Ovid MEDLINE, EMBASE, EBM Reviews, CINAHL and PsycInfo between 1995 and 2015. The quality criteria framework endorsed by the International Patient Decision Aids Standards (IPDAS) was used to assess usefulness.
Seventeen DA interventions for patients, their surrogates or health professionals were included. Half the DAs were designed for self-administration and few described use of facilitators for decision-making.
options and associated harms and benefits, and patient preferences were most commonly included. Patient values, treatment goals, numeric disease-specific prognostic information and financial implications of decisions were generally not covered. DAs at the end of life are generally acceptable by users, and appear to increase knowledge and reduce decisional conflict but this effectiveness is mainly based on low-level evidence.
Continuing evaluation of DAs in routine practice to support advance care planning is worth exploring further. In particular, this would be useful for conditions such as cancer, or situations such as major surgery where prognostic data is known, or in dementia where concordance on primary goals of care between surrogates and the treating team can be improved.
Given the sensitivities of end-of-life, self-administered DAs are inappropriate in this context and genuine informed decision-making cannot happen while those gaps in the instruments remain.
描述可用于帮助老年临终患者做出明智选择的决策辅助工具（DA）的范围，并评估其有效性或可接受性。
检索策略涵盖1995年至2015年期间的PubMed、Scopus、Ovid MEDLINE、EMBASE、循证医学综述、护理学与健康领域数据库（CINAHL）和心理学文摘数据库（PsycInfo）。采用国际患者决策辅助工具标准（IPDAS）认可的质量标准框架来评估其有用性。
纳入了17项针对患者、其代理人或医疗专业人员的DA干预措施。一半的决策辅助工具设计用于自我管理，很少有工具描述使用促进者进行决策。
选项以及相关的危害和益处，以及患者偏好是最常包含的内容。患者价值观、治疗目标、特定疾病的数字预后信息以及决策的财务影响通常未被涵盖。临终阶段的决策辅助工具通常为用户所接受，并且似乎能增加知识并减少决策冲突，但这种有效性主要基于低水平证据。
在常规实践中持续评估决策辅助工具以支持预先护理计划值得进一步探索。特别是，这对于诸如癌症等疾病，或已知预后数据的重大手术等情况，或在痴呆症中，当代理人与治疗团队之间在主要护理目标上的一致性可以得到改善时，将是有用的。
鉴于临终阶段的敏感性，自我管理的决策辅助工具在这种情况下是不合适的，并且在工具存在这些差距的情况下，真正的明智决策无法实现。
