Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
J Surg Res. 2019 Mar;235:350-366. doi: 10.1016/j.jss.2018.09.017. Epub 2018 Nov 13.
With continuous advances in medicine, patients are faced with several medical or surgical treatment options for their health conditions. Decision aids may be useful in helping patients navigate these options and choose based on their goals and values. We reviewed the literature to identify decision aids and better understand the effect on patient decision-making. We identified 107 decision aids designed to help patients make decisions between medical treatment or screening options; 39 decision aids were used to help patients choose between a medical and surgical treatment, and five were identified that aided patients in deciding between a major open surgical procedure and a less invasive option. Many of the decision aids were used to help patients decide between prostate, colorectal, and breast cancer screening or treatment options. Although most decision aids were not associated with a significant effect on the actual decision made, they were largely associated with increased patient knowledge, decreased decisional conflict, more accurate perception of risks, increased satisfaction with their decision, and no increase in anxiety surrounding their decision. These data identify a gap in use of decision aids in surgical decision-making and highlight the potential to help surgical patients make value-based, knowledgeable decisions regarding their treatment.
随着医学的不断进步，患者在面对自身健康状况时，会面临多种医疗或手术治疗选择。决策辅助工具可能有助于患者了解这些选择，并根据其目标和价值观做出选择。我们查阅了文献，以确定决策辅助工具，并更好地了解其对患者决策的影响。我们确定了 107 种旨在帮助患者在医疗治疗或筛查选择之间做出决策的决策辅助工具；39 种决策辅助工具用于帮助患者在医疗和手术治疗之间做出选择，5 种用于帮助患者在大手术和微创手术之间做出选择。许多决策辅助工具用于帮助患者在前列腺癌、结直肠癌和乳腺癌筛查或治疗选择之间做出决定。尽管大多数决策辅助工具对实际做出的决策没有显著影响，但它们在很大程度上与增加患者的知识、降低决策冲突、更准确地感知风险、提高对决策的满意度以及不增加对决策的焦虑有关。这些数据表明，在手术决策中使用决策辅助工具的情况存在差距，并强调了帮助外科患者做出基于价值和知情的治疗决策的潜力。
