1 Division of Population Medicine, School of Medicine, University Hospital of Wales, Cardiff University, Cardiff, UK.
2 Bangor Institute for Health & Medical Research, Bangor University, Bangor, UK.
Palliat Med. 2019 Sep;33(8):985-1002. doi: 10.1177/0269216319854186. Epub 2019 Jun 14.
Many decisions are made by patients in their last months of life, creating complex decision-making needs for these individuals. Identifying whether currently existing patient decision aids address the full range of these patient decision-making needs will better inform end-of-life decision support in clinical practice.
This systematic review aimed to (a) identify the range of patients' decision-making needs and (b) assess the extent to which patient decision aids address these needs.
MEDLINE, PsycINFO and CINAHL electronic literature databases were searched (January 1990-January 2017), supplemented by hand-searching strategies. Eligible literature reported patient decision-making needs throughout end-of-life decision-making or were evaluations of patient decision aids. Identified decision aid content was mapped onto and assessed against all patient decision-making needs that were deemed 'addressable'.
Twenty-two studies described patient needs, and seven end-of-life patient decision aids were identified. Patient needs were categorised, resulting in 48 'addressable' needs. Mapping needs to patient decision aid content showed that 17 patient needs were addressed by current patient decision aids. The most substantial gaps included inconsistent acknowledgement, elicitation and documentation of how patient needs varied individually for the level of information provided, the extent patients wanted to participate in decision-making, and the extent they wanted their families and associated healthcare professionals to participate.
Patient decision-making needs are broad and varied. Currently developed patient decision aids are insufficiently addressing patient decision-making needs. Improving future end-of-life patient decision aid content through five key suggestions could improve patient-focused decision-making support at the end of life.
许多决策是患者在生命的最后几个月做出的，这为他们创造了复杂的决策需求。确定目前现有的患者决策辅助工具是否涵盖了这些患者决策需求的全部范围，将更好地为临床实践中的临终决策提供支持。
本系统评价旨在（a）确定患者决策需求的范围，（b）评估患者决策辅助工具在多大程度上满足这些需求。
检索了 MEDLINE、PsycINFO 和 CINAHL 电子文献数据库（1990 年 1 月至 2017 年 1 月），并辅以手工检索策略。符合条件的文献报告了整个临终决策过程中的患者决策需求，或评估了患者决策辅助工具。确定的决策辅助内容与所有被认为“可解决”的患者决策需求进行了映射和评估。
22 项研究描述了患者的需求，确定了 7 种临终患者决策辅助工具。患者需求进行了分类，产生了 48 个“可解决”的需求。将需求映射到患者决策辅助工具的内容上，发现当前的患者决策辅助工具解决了 17 个患者需求。最大的差距包括不一致地承认、引出和记录患者的需求如何因提供的信息量、患者希望参与决策的程度以及他们希望其家人和相关医疗保健专业人员参与的程度而异。
患者的决策需求广泛而多样。目前开发的患者决策辅助工具不能充分满足患者的决策需求。通过以下五个关键建议来改进未来临终患者决策辅助工具的内容，可以改善临终时以患者为中心的决策支持。
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