McAlpine Kristen, Lewis Krystina B, Trevena Lyndal J, Stacey Dawn
Kristen McAlpine, Krystina B. Lewis, and Dawn Stacey, University of Ottawa; Dawn Stacey, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and Lyndal J. Trevena, University of Sydney, Sydney, New South Wales, Australia.
JCO Clin Cancer Inform. 2018 Dec;2:1-13. doi: 10.1200/CCI.17.00148.
To determine the effectiveness of patient decision aids when used with patients who face cancer-related decisions.
Two reviewers independently screened the 105 trials in the original 2017 Cochrane review to identify eligible trials of patient decision aids across the cancer continuum. Primary outcomes were attributes of the choice and decision-making process. Secondary outcomes were patient behavior and health system effects. A meta-analysis was conducted for similar outcome measures.
Forty-six trials evaluated patient decision aids for cancer care, including 27 on screening decisions (59%), 12 on treatments (26%), four on genetic testing (9%), and three on prevention (6%). Common decisions were aboutprostate cancer screening (30%), colorectal cancer screening (22%), breast cancer treatment (13%), and prostate cancer treatment (9%). Compared with the control groups (usual care or alternative interventions), the patient decision aid group improved the match between the chosen option and the features that mattered most to the patient as demonstrated by improved knowledge (weighted mean difference, 12.88 of 100; 95% CI, 9.87 to 15.89; 24 trials), accurate risk perception (risk ratio [RR], 1.77; 95% CI, 1.22 to 2.56; six trials), and value-choice agreement (RR, 2.76; 95% CI, 1.57 to 4.84; nine trials). Compared with controls, the patient decision aid group improved the decision-making process with decreased decisional conflict (weighted mean difference, -9.56 of 100; 95% CI, -13.90 to -5.23; 12 trials), reduced clinician-controlled decision making (RR, 0.57; 95% CI, 0.41 to 0.79; eight trials), and fewer patients being indecisive (RR, 0.59; 95% CI, 0.45 to 0.78; nine trials).
Patient decision aids improve the attributes of the choice made and decision-making process for patients who face cancer-related decisions.
确定患者决策辅助工具应用于面临癌症相关决策的患者时的有效性。
两名评审员独立筛选了2017年Cochrane系统评价原始文献中的105项试验，以确定癌症全程中患者决策辅助工具的合格试验。主要结局为选择和决策过程的属性。次要结局为患者行为和卫生系统效应。对相似的结局指标进行荟萃分析。
46项试验评估了癌症护理患者决策辅助工具，其中27项涉及筛查决策（59%），12项涉及治疗决策（26%），4项涉及基因检测决策（9%），3项涉及预防决策（6%）。常见决策包括前列腺癌筛查（30%）、结直肠癌筛查（22%）、乳腺癌治疗（13%）和前列腺癌治疗（9%）。与对照组（常规护理或替代干预措施）相比，患者决策辅助工具组改善了所选选项与对患者最重要特征之间的匹配度，表现为知识水平提高（加权均数差值为100分制中的12.88分；95%置信区间为9.87至15.89；24项试验）、风险感知准确（风险比[RR]为1.77；95%置信区间为1.22至2.56；6项试验）以及价值选择一致性（RR为2.76；95%置信区间为1.57至4.84；9项试验）。与对照组相比，患者决策辅助工具组改善了决策过程，决策冲突减少（加权均数差值为100分制中的-9.56分；95%置信区间为-13.90至-5.23；12项试验），临床医生主导的决策减少（RR为0.57；95%置信区间为0.41至0.79；8项试验），犹豫不决的患者减少（RR为0.59；95%置信区间为0.45至0.78；9项试验）。
患者决策辅助工具可改善面临癌症相关决策患者的选择属性和决策过程。
