Zadro Joshua R, Traeger Adrian C, Décary Simon, O'Keeffe Mary
Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
BMJ Evid Based Med. 2020 May 21. doi: 10.1136/bmjebm-2020-111371.
Patient decision aids are evidence-based tools designed to help patients make specific and deliberated choices among healthcare options. Research shows that patient decision aids increase knowledge, accuracy of risk perceptions, alignment of care with patient values and preferences, and patient involvement in decision making. Some patient decision aids can reduce the use of invasive and potentially low-value procedures. On this basis, clinical practice guidelines and international organisations have begun to recommend the use of patient decision aids and shared decision making as a strategy to reduce medical overuse. Although patient decision aids hold promise for improving healthcare, there are fundamental issues with patient decision aids that need to be addressed before further progress can be made. The problems with patient decision aids are: (1) Guidelines for developing patient decision aids may not be sufficient to ensure developers select the best available evidence and present it appropriately; (2) Biased presentation of low-certainty evidence is common and (3) Biased presentation of low-certainty evidence is misleading, and could inadvertently support, low-value care. We explore these issues in the article and present a case study of online patient decision aids for musculoskeletal pain. We suggest ways to ensure patient decision aids help patients understand the evidence and, where possible, support high-quality care.
患者决策辅助工具是基于证据的工具，旨在帮助患者在医疗保健选项中做出具体且经过深思熟虑的选择。研究表明，患者决策辅助工具能增加知识、提高风险认知的准确性、使医疗护理与患者价值观和偏好相匹配，并提高患者参与决策的程度。一些患者决策辅助工具可以减少侵入性和潜在低价值程序的使用。在此基础上，临床实践指南和国际组织已开始推荐使用患者决策辅助工具和共同决策作为减少医疗过度使用的策略。尽管患者决策辅助工具有望改善医疗保健，但在取得进一步进展之前，患者决策辅助工具存在一些基本问题需要解决。患者决策辅助工具存在的问题包括：（1）开发患者决策辅助工具的指南可能不足以确保开发者选择最佳可得证据并恰当地呈现；（2）对低确定性证据的有偏差呈现很常见；（3）对低确定性证据的有偏差呈现具有误导性，可能会无意中支持低价值护理。我们在本文中探讨这些问题，并展示一个针对肌肉骨骼疼痛的在线患者决策辅助工具的案例研究。我们提出了一些方法，以确保患者决策辅助工具能帮助患者理解证据，并在可能的情况下支持高质量护理。
