Hajizadeh Negin, Uhler Lauren, Herman Saori Wendy, Lester Janice
Department of Medicine (NH, LU) and Health Sciences Library (SWH), Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA.
Long Island Jewish Medical Center Health Sciences Library, North Shore LIJ Health System, New Hyde Park, NY, USA (JL).
MDM Policy Pract. 2016 Jul 7;1(1):2381468316642237. doi: 10.1177/2381468316642237. eCollection 2016 Jul-Dec.
Whether shared decision making (SDM) has been evaluated for end-of-life (EOL) decisions as compared to other forms of decision making has not been studied. To summarize the evidence on SDM being associated with better outcomes for EOL decision making, as compared to other forms of decision making. PubMed, Web of Science, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, and CINAHL databases were searched through April 2014. Studies were selected that evaluated SDM, compared to any other decision making style, for an EOL decision. Components of SDM tested, comparators to SDM, EOL decision being assessed, and outcomes measured. Seven studies met the inclusion criteria (three experimental and four observational studies). Results were analyzed using narrative synthesis. All three experimental studies compared SDM interventions to usual care. The four observational studies compared SDM to doctor-controlled decision making, or reported the correlation between level of SDM and outcomes. Components of SDM specified in each study differed widely, but the component most frequently included was presenting information on the risks/benefits of treatment choices (five of seven studies). The outcome most frequently measured was communication, although with different measurement tools. Other outcomes included decisional conflict, trust, satisfaction, and "quality of dying." We could not analyze the strength of evidence for a given outcome due to heterogeneity in the outcomes reported and measurement tools. There is insufficient evidence supporting SDM being associated with improved outcomes for EOL decisions as opposed to other forms of decision making. Future studies should describe which components of SDM are being tested, outline the comparator decision making style, and use validated tools to measure outcomes.
与其他形式的决策相比，共享决策（SDM）是否已针对临终（EOL）决策进行评估尚未得到研究。总结与其他形式的决策相比，共享决策与更好的临终决策结果相关的证据。检索了截至2014年4月的PubMed、科学网、Cochrane对照试验中央注册库、EMBASE、PsycINFO和CINAHL数据库。选择了评估共享决策（与任何其他决策风格相比）用于临终决策的研究。测试的共享决策组件、共享决策的比较对象、评估的临终决策以及测量的结果。七项研究符合纳入标准（三项实验性研究和四项观察性研究）。使用叙述性综合分析结果。所有三项实验性研究将共享决策干预与常规护理进行了比较。四项观察性研究将共享决策与医生控制的决策进行了比较，或报告了共享决策水平与结果之间的相关性。每项研究中指定的共享决策组件差异很大，但最常包括的组件是提供有关治疗选择风险/益处的信息（七项研究中的五项）。最常测量的结果是沟通，尽管使用了不同的测量工具。其他结果包括决策冲突、信任、满意度和“死亡质量”。由于报告的结果和测量工具存在异质性，我们无法分析给定结果的证据强度。与其他形式的决策相比，没有足够的证据支持共享决策与改善临终决策结果相关。未来的研究应描述正在测试的共享决策组件，概述比较决策风格，并使用经过验证的工具来测量结果。
