患者决策辅助工具在妇产科中促进共享决策的系统评价和荟萃分析。

Patient Decision Aids to Facilitate Shared Decision Making in Obstetrics and Gynecology: A Systematic Review and Meta-analysis.

机构信息

Robinson Research Institute, University of Adelaide, and the Department of Perinatal Medicine, Women's and Children's Hospital, Adelaide, Australia; the Centre for Biostatistics, University of Manchester, Manchester, United Kingdom; the Cochrane Menstrual Disorders and Subfertility Group, University of Auckland, Auckland, New Zealand; and the Institute for Women's Health, University College London, London, and the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.

出版信息

Obstet Gynecol. 2020 Feb;135(2):444-451. doi: 10.1097/AOG.0000000000003664.

DOI:10.1097/AOG.0000000000003664

PMID:31923056

Abstract

OBJECTIVE

To assess the effectiveness of patient decision aids to facilitate shared decision making in obstetrics and gynecology.

DATA SOURCES

We searched ClinicalTrials.gov, MEDLINE, CENTRAL, Cochrane Gynaecology and Fertility specialized register, CINAHL, and EMBASE from 1946 to July 2019.

METHODS OF STUDY SELECTION

We selected randomized controlled trials comparing patient decision aids with usual clinical practice or a control intervention.

TABULATION, INTEGRATION, AND RESULTS: Thirty-five randomized controlled trials, which reported data from 9,790 women, were included. Patient decision aids were evaluated within a wide range of clinical scenarios relevant to obstetrics and gynecology, including contraception, vaginal birth after cesarean delivery, and pelvic organ prolapse. Study characteristics and quality were recorded for each study. The meta-analysis was based on random-effects methods for pooled data. A standardized mean difference of 0.2 is considered small, 0.5 moderate, and 0.8 large. When compared with usual clinical practice, the use of patient decision aids reduced decisional conflict (standardized mean difference -0.23; 95% CI -0.36, to -0.11; 19 trials; 4,624 women) and improved patient knowledge (standardized mean difference 0.58; 95% CI 0.44 to 0.71; 17 trials; 4,375 women). There was no difference in patient anxiety (standardized mean difference -0.04; 95% CI -0.14 to 0.06; 12 trials; 2,714 women) or satisfaction (standardized mean difference 0.17; 95% CI 0.09 to 0.24; 6 trials; 2,718 women).

CONCLUSION

Patient decision aids are effective in facilitating shared decision making and can be helpful in clinical practice to support patient centered care informed by the best evidence.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO International Register of Systematic Reviews, www.crd.york.ac.uk/prospero/89953, CRD42018089953.

摘要

目的

评估患者决策辅助工具在妇产科中促进共享决策的有效性。

资料来源

我们检索了 ClinicalTrials.gov、MEDLINE、CENTRAL、Cochrane 妇科和生育专门登记处、CINAHL 和 EMBASE，检索时间从 1946 年到 2019 年 7 月。

研究选择方法

我们选择了比较患者决策辅助工具与常规临床实践或对照干预的随机对照试验。

表格，整合和结果：35 项随机对照试验，共报告了 9790 名女性的数据，被纳入研究。患者决策辅助工具在与妇产科相关的广泛临床情况下进行了评估，包括避孕、剖宫产后阴道分娩和盆腔器官脱垂。为每个研究记录了研究特征和质量。荟萃分析基于随机效应方法进行汇总数据。标准化均数差值为 0.2 被认为是小的，0.5 是中等的，0.8 是大的。与常规临床实践相比，使用患者决策辅助工具可降低决策冲突（标准化均数差值 -0.23；95%置信区间 -0.36 至 -0.11；19 项试验；4624 名女性）和提高患者知识（标准化均数差值 0.58；95%置信区间 0.44 至 0.71；17 项试验；4375 名女性）。患者焦虑（标准化均数差值 -0.04；95%置信区间 -0.14 至 0.06；12 项试验；2714 名女性）或满意度（标准化均数差值 0.17；95%置信区间 0.09 至 0.24；6 项试验；2718 名女性）无差异。