Coronado-Vázquez Valle, Canet-Fajas Carlota, Delgado-Marroquín Maria Teresa, Magallón-Botaya Rosa, Romero-Martín Macarena, Gómez-Salgado Juan
Aragonese Primary Care Research Group B21-17R. Health Research Institute of Aragon (IIS). Department of Nursing. Faculty of Health Sciences. Catholic University of Ávila. Castilla La Mancha Health Service, Toledo.
Bioethics Research Group. Delicias Sur Primary Care Health Center, Zaragoza.
Medicine (Baltimore). 2020 Aug 7;99(32):e21389. doi: 10.1097/MD.0000000000021389.
Shared decision making (SDM) is a process within the physician-patient relationship applicable to any clinical action, whether diagnostic, therapeutic, or preventive in nature. It has been defined as a process of mutual respect and participation between the doctor and the patient. The aim of this study is to determine the effectiveness of decision aids (DA) in primary care based on changes in adherence to treatments, knowledge, and awareness of the disease, conflict with decisions, and patients' and health professionals' satisfaction with the intervention.
A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in Medline, CINAHL, Embase, the Cochrane Central Register of Controlled Trials, and the NHS Economic Evaluation Database. The inclusion criteria were randomized clinical trials as study design; use of SDM with DA as an intervention; primary care as clinical context; written in English, Spanish, and Portuguese; and published between January 2007 and January 2019. The risk of bias of the included studies in this review was assessed according to the Cochrane Collaboration's tool.
Twenty four studies were selected out of the 201 references initially identified. With the use of DA, the use of antibiotics was reduced in cases of acute respiratory infection and decisional conflict was decreased when dealing with the treatment choice for atrial fibrillation and osteoporosis. The rate of determination of prostate-specific antigen (PSA) in the prostate cancer screening decreased and colorectal cancer screening increased. Both professionals and patients increased their knowledge about depression, type 2 diabetes, and the perception of risk of acute myocardial infarction at 10 years without statins and with statins. The satisfaction was greater with the use of DA in choosing the treatment for depression, in cardiovascular risk management, in the treatment of low back pain, and in the use of statin therapy in diabetes. Blinding of outcomes assessment was the most common bias.
DA used in primary care are effective to reduce decisional conflict and improve knowledge on the disease and treatment options, awareness of risk, and satisfaction with the decisions made. More studies are needed to assess the impact of shared decision making in primary care.
共同决策（SDM）是医患关系中的一个过程，适用于任何临床行为，无论其本质是诊断性、治疗性还是预防性的。它被定义为医生与患者之间相互尊重和参与的过程。本研究的目的是基于治疗依从性、疾病知识和认知、决策冲突以及患者和卫生专业人员对干预措施的满意度的变化，确定决策辅助工具（DA）在初级保健中的有效性。
按照系统评价和Meta分析的首选报告项目指南，在Medline、CINAHL、Embase、Cochrane对照试验中央注册库和英国国家医疗服务体系经济评价数据库中进行了系统评价。纳入标准为：作为研究设计的随机临床试验；使用以DA为干预措施的SDM；以初级保健为临床背景；以英语、西班牙语和葡萄牙语撰写；2007年1月至2019年1月期间发表。根据Cochrane协作网的工具评估本评价中纳入研究的偏倚风险。
从最初识别的201篇参考文献中筛选出24项研究。使用DA后，急性呼吸道感染病例中抗生素的使用减少，在处理房颤和骨质疏松症的治疗选择时决策冲突减少。前列腺癌筛查中前列腺特异性抗原（PSA）的检测率降低，而结直肠癌筛查增加。专业人员和患者对抑郁症、2型糖尿病以及在未使用他汀类药物和使用他汀类药物情况下10年急性心肌梗死风险感知的知识均有所增加。在抑郁症治疗选择、心血管风险管理、腰痛治疗以及糖尿病中他汀类药物治疗的使用方面，使用DA的满意度更高。结果评估的盲法是最常见的偏倚。
初级保健中使用的DA可有效减少决策冲突，提高对疾病和治疗选择的知识、风险意识以及对所做决策的满意度。需要更多研究来评估初级保健中共同决策的影响。
