Rashid Mohammed A, Lovick Sophie, Llanwarne Nadia R
UCL Medical School, London, UK.
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Fam Pract. 2018 Mar 27;35(2):142-150. doi: 10.1093/fampra/cmx088.
Although attention deficit hyperactivity disorder (ADHD) is a common condition for which pharmacotherapy is considered an effective treatment, guidelines on the treatment of ADHD have been challenging to implement. Considering the views of patients and caregivers involved in medication-taking could help shed light on these challenges.
This review combines the findings of individual studies of medication-taking experiences in ADHD in order to guide clinicians to effectively share decisions about treatment.
Five databases (MEDLINE, Embase, PsycINFO, SCOPUS and CINAHL) were systematically searched for relevant published research articles. Articles were assessed for quality using a Critical Appraisal Skills Programme checklist, and synthesis was performed using meta-ethnography.
Thirty-one articles were included in the final synthesis, comprising studies of caregivers, paediatric patients and adult patients across seven countries. Findings were categorized into five different constructs, including coming to terms with ADHD, anticipated concerns about medication, experiences of the effects of medication, external influences and the development of self-management. The synthesis demonstrates that decisions surrounding medication-taking for ADHD evolve as the child patient enters adulthood and moves towards autonomy and self-management. In all parts of this journey, decisions are shaped by a series of 'trade-offs', where potential benefits and harms of medication are weighed up.
This review offers a comprehensive insight into medication-taking experiences in ADHD. By considering the shifting locus of decision-making over time and the need for individuals and families to reconcile a variety of external influences, primary care and mental health clinicians can engage in holistic conversations with their patients to share decisions effectively.
尽管注意力缺陷多动障碍（ADHD）是一种常见病症，药物治疗被认为是有效的治疗方法，但ADHD的治疗指南在实施方面一直具有挑战性。考虑参与服药的患者和照料者的观点有助于阐明这些挑战。
本综述综合了关于ADHD服药经历的个体研究结果，以指导临床医生有效地共同做出治疗决策。
系统检索了五个数据库（MEDLINE、Embase、PsycINFO、SCOPUS和CINAHL），以查找相关的已发表研究文章。使用批判性评估技能计划清单对文章质量进行评估，并采用元民族志进行综合分析。
最终综合分析纳入了31篇文章，包括对七个国家的照料者、儿科患者和成年患者的研究。研究结果分为五个不同的类别，包括接受ADHD、对药物的预期担忧、药物效果的体验、外部影响以及自我管理的发展。综合分析表明，随着儿童患者进入成年期并走向自主和自我管理，围绕ADHD服药的决策也在演变。在这个过程的各个阶段，决策都受到一系列“权衡”的影响，即权衡药物的潜在益处和危害。
本综述全面深入地了解了ADHD的服药经历。通过考虑决策地点随时间的变化以及个人和家庭协调各种外部影响的必要性，初级保健和心理健康临床医生可以与患者进行全面的对话，以有效地共同做出决策。
