Section of Plastic Surgery, University of Michigan, Ann Arbor, MI.
Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Med Decis Making. 2019 Jan;39(1):5-20. doi: 10.1177/0272989X18803879.
The decision-making process for women considering breast reconstruction following mastectomy is complex. Research suggests that fewer than half of women undergoing mastectomy have adequate knowledge and make treatment decisions that are concordant with their underlying values. This systematic review assesses the feasibility and efficacy of preoperative decision aids (DAs) to improve the patient decision-making process for breast reconstruction.
A systematic review was performed using PubMed, Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Databases published prior to January 4, 2018. Studies that assessed the impact of a DA on patient decision making for breast reconstruction were identified. The effect of preoperative DAs on decisional conflict in randomized controlled trials (RCTs) was measured with inverse variance-weighted mean differences (mean difference [MD] ± 95% confidence interval [CI]).
Among 1299 unique articles identified, 1197 were excluded after reviewing titles and abstracts against selection criteria. Among the 17 studies included in this review, 11 assessed the efficacy of DAs for breast reconstruction and 6 additional studies described the development and usability of these DAs. Studies suggest that DAs reduce patient-reported decisional conflict (MD, -4.55 [95% CI, -8.65 to -0.45], P = 0.03 in the fixed-effects model and MD, -4.70 [95% CI, -10.75 to 1.34], P = 0.13 in the random-effects model). Preoperative DAs also improved patient satisfaction with information and perceived involvement in the decision-making process.
The existing literature suggests that DAs reduce decisional conflict, improve self-reported satisfaction with information, and improve perceived involvement in the decision-making process for women considering breast reconstruction.
女性在接受乳房切除术（mastectomy）后考虑乳房重建（breast reconstruction）的决策过程较为复杂。研究表明，接受乳房切除术的女性中，不到一半的人具备足够的知识，并且做出的治疗决策与自身的潜在价值观相符。本系统评价评估了术前决策辅助工具（DA）改善乳房重建患者决策过程的可行性和效果。
使用 PubMed、Ovid MEDLINE、EMBASE、CINAHL 和 Cochrane 数据库，对截至 2018 年 1 月 4 日之前发表的研究进行了系统评价。识别出评估 DA 对乳房重建患者决策影响的研究。采用Inverse variance-weighted mean differences（mean difference [MD] ± 95% confidence interval [CI]），测量随机对照试验（RCT）中术前 DAs 对决策冲突的影响。
在 1299 篇独特的文章中，1197 篇在根据选择标准审查标题和摘要后被排除。在本综述中纳入的 17 项研究中，有 11 项评估了 DA 对乳房重建的疗效，还有 6 项研究描述了这些 DA 的开发和可用性。研究表明，DA 可降低患者报告的决策冲突（MD，-4.55 [95% CI，-8.65 至 -0.45]，固定效应模型 P = 0.03；MD，-4.70 [95% CI，-10.75 至 1.34]，随机效应模型 P = 0.13）。术前 DAs 还提高了患者对信息的满意度和对决策过程的参与感。
现有文献表明，DA 可降低决策冲突，提高患者对信息的满意度，增强其对决策过程的参与感，适用于考虑乳房重建的女性。
