School of Nursing, University of Ottawa, Ottawa, ON, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Med Decis Making. 2020 Apr;40(3):379-398. doi: 10.1177/0272989X20911870.
The Ottawa Decision Support Framework (ODSF) has guided practitioners and patients facing difficult decisions for 20 years. It asserts that decision support interventions that address patients' decisional needs improve decision quality. To update the ODSF based on a synthesis of evidence. . We conducted an overview of systematic reviews, searching 9 electronic databases. Eligible reviews included decisional needs assessments, decision support interventions, and decisional outcome measures guided by the ODSF. We extracted data and synthesized results narratively. Eight ODSF developers/expert users from 4 disciplines revised the ODSF. Of 4656 citations, we identified 4 eligible reviews (>250 studies, >100 different decisions, >50,000 patients, 18 countries, 5 continents). They reported current ODSF decisional needs and their most frequent manifestations in the areas of inadequate knowledge/information, unclear values, decisional conflict/uncertainty, and inadequate support. They uncovered 11 new manifestations of 6 decisional needs. Using the Decisional Conflict Scale (DCS) to assess decisional needs, average scores were elevated at baseline and declined shortly after decision making, even without information interventions. Patient decision aids were superior to usual care in reducing total DCS scores and improving decision quality. We revised the ODSF by refining definitions of 6 decisional needs and adding new interventions to address 4 needs. We added a decision process outcome and eliminated secondary outcomes unlikely to improve across a range of decisions, retaining the implementation/continuance of the chosen option and appropriate use/costs of health services. . We updated the ODSF to reflect the current evidence and identified implications for practice and further research.
渥太华决策支持框架 (ODSF) 已经指导了 20 年来面临困难决策的从业者和患者。它断言，满足患者决策需求的决策支持干预措施可以提高决策质量。为了根据证据综合更新 ODSF。。我们进行了系统评价综述，搜索了 9 个电子数据库。符合条件的综述包括决策需求评估、决策支持干预措施和 ODSF 指导的决策结果衡量标准。我们提取数据并进行了叙述性综合。来自 4 个学科的 8 名 ODSF 开发人员/专家用户对 ODSF 进行了修订。在 4656 条引文，我们确定了 4 项符合条件的综述（>250 项研究，>100 个不同的决策，>50000 名患者，18 个国家，5 个大陆）。他们报告了当前 ODSF 的决策需求及其在知识/信息不足、价值观不明确、决策冲突/不确定性和支持不足等领域的最常见表现。他们发现了 6 个决策需求的 11 个新表现形式。使用决策冲突量表 (DCS) 评估决策需求，基线时平均得分较高，即使没有信息干预，决策后不久也会下降。患者决策辅助工具在降低总 DCS 评分和提高决策质量方面优于常规护理。我们通过细化 6 个决策需求的定义并增加新的干预措施来解决 4 个需求来修订 ODSF。我们增加了一个决策过程结果，并消除了不太可能在一系列决策中改善的次要结果，保留了所选方案的实施/继续以及医疗服务的适当使用/成本。。我们更新了 ODSF，以反映当前的证据，并确定了对实践和进一步研究的影响。
