Staszewska Anna, Zaki Pearl, Lee Joon
Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
JMIR Med Inform. 2017 Oct 6;5(4):e36. doi: 10.2196/medinform.6405.
Shared decision making (SDM) is important in achieving patient-centered care. SDM tools such as decision aids are intended to inform the patient. When used to assist in decision making between treatments, decision aids have been shown to reduce decisional conflict, increase ease of decision making, and increase modification of previous decisions.
The purpose of this systematic review is to assess the impact of computerized decision aids on patient-centered outcomes related to SDM for seriously ill patients.
PubMed and Scopus databases were searched to identify randomized controlled trials (RCTs) that assessed the impact of computerized decision aids on patient-centered outcomes and SDM in serious illness. Six RCTs were identified and data were extracted on study population, design, and results. Risk of bias was assessed by a modified Cochrane Risk of Bias Tool for Quality Assessment of Randomized Controlled Trials.
Six RCTs tested decision tools in varying serious illnesses. Three studies compared different computerized decision aids against each other and a control. All but one study demonstrated improvement in at least one patient-centered outcome. Computerized decision tools may reduce unnecessary treatment in patients with low disease severity in comparison with informational pamphlets. Additionally, electronic health record (EHR) portals may provide the opportunity to manage care from the home for individuals affected by illness. The quality of decision aids is of great importance. Furthermore, satisfaction with the use of tools is associated with increased patient satisfaction and reduced decisional conflict. Finally, patients may benefit from computerized decision tools without the need for increased physician involvement.
Most computerized decision aids improved at least one patient-centered outcome. All RCTs identified were at a High Risk of Bias or Unclear Risk of Bias. Effort should be made to improve the quality of RCTs testing SDM aids in serious illness.
共同决策（SDM）对于实现以患者为中心的医疗至关重要。诸如决策辅助工具之类的SDM工具旨在为患者提供信息。当用于协助治疗方案的决策时，决策辅助工具已被证明可以减少决策冲突、提高决策的便利性，并增加对先前决策的调整。
本系统评价的目的是评估计算机化决策辅助工具对重症患者与SDM相关的以患者为中心的结局的影响。
检索PubMed和Scopus数据库，以识别评估计算机化决策辅助工具对重症患者以患者为中心的结局和SDM影响的随机对照试验（RCT）。共识别出6项RCT，并提取了关于研究人群、设计和结果的数据。采用改良的Cochrane随机对照试验质量评估偏倚风险工具评估偏倚风险。
6项RCT在不同的重症疾病中测试了决策工具。3项研究将不同的计算机化决策辅助工具相互比较，并与对照组进行比较。除1项研究外，所有研究均显示至少一项以患者为中心的结局有所改善。与信息手册相比，计算机化决策工具可能会减少疾病严重程度较低患者的不必要治疗。此外，电子健康记录（EHR）门户可能为患病个体提供在家中管理护理服务的机会。决策辅助工具的质量至关重要。此外，对工具使用的满意度与患者满意度的提高和决策冲突的减少相关。最后，患者可能从计算机化决策工具中受益，而无需增加医生的参与。
大多数计算机化决策辅助工具至少改善了一项以患者为中心的结局。所有识别出的RCT均存在高偏倚风险或偏倚风险不明确。应努力提高在重症疾病中测试SDM辅助工具的RCT的质量。
