Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada.
Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada; Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
Patient Educ Couns. 2020 Aug;103(8):1467-1497. doi: 10.1016/j.pec.2020.02.029. Epub 2020 Feb 28.
Our objective was to describe interventions that aim to improve communication of prognosis to adult patients and to summarize the effect of interventions.
We included randomized controlled trials of interventions that included prognosis delivery. We excluded studies of decision aids. Our analysis was a narrative synthesis of interventions and outcomes.
Our search identified 1151 unique records. After screening, and full text review we included 21 reports from 17 RCTs. Only 2 studies used a prediction model to generate prognostic estimates. Four studies used education, ten used patient mediated interventions, and 2 used coordination of care. In some studies education that includes prognosis improves patient reported outcomes, communication and treatment decisions, patient mediated interventions can increase the number of questions patients ask about prognosis. Coordination of care may improve satisfaction.
Education for clinicians that includes teaching about how to communicate prognosis may improve patient reported outcomes. Patient mediated interventions can increase the number of prognosis related questions asked by patients.
Communication skills training that includes training on delivering prognosis may improve communication and patient reported outcomes, but the evidence is uncertain. Giving patients question prompt lists can help them ask more prognosis related questions.
本研究旨在描述旨在改善成人患者预后沟通的干预措施，并总结干预措施的效果。
我们纳入了包含预后传递的干预措施的随机对照试验。我们排除了决策辅助工具的研究。我们的分析是对干预措施和结果的叙述性综合。
我们的搜索确定了 1151 条独特记录。经过筛选和全文审查，我们纳入了来自 17 项 RCT 的 21 份报告。只有 2 项研究使用预测模型生成预后估计。四项研究使用教育，十项研究使用患者介导的干预措施，两项研究使用护理协调。在一些研究中，包括预后在内的教育可以改善患者报告的结局、沟通和治疗决策，患者介导的干预措施可以增加患者询问预后的问题数量。护理协调可能会提高满意度。
包含教授如何沟通预后的内容的临床医生教育可能会改善患者报告的结局。患者介导的干预措施可以增加患者提出的与预后相关问题的数量。
包括预后传递培训的沟通技巧培训可能会改善沟通和患者报告的结局，但证据不确定。给患者问题提示清单可以帮助他们提出更多与预后相关的问题。
