Department of Economics, Universitat Rovira i Virgili, Spain; Centre de Recerca en Economia i Sostenibilitat (ECO-SOS), Spain.
Department of Economics, Universitat Rovira i Virgili, Spain; Research Group on Statistics, Economic Evaluation and Health (GRAEES), Spain.
Patient Educ Couns. 2021 Aug;104(8):1933-1944. doi: 10.1016/j.pec.2021.01.032. Epub 2021 Jan 30.
To explore the barriers to and facilitators of healthcare professionals' implementation of SDM regarding screening programmes.
A systematic review was conducted in PubMed, Cochrane Library, CINHAL, and PsyscInfo. The barriers and facilitators identified were classified into three factors based on their origin: patients, healthcare system performance, and healthcare professionals themselves.
Eight studies were selected: seven related to cancer screening. The most significant facilitators were literacy and interest in active participation, both of which have their origins in patients. The most significant barriers identified for the first time in a systematic review were legal conflict, lack of remuneration and lack of flexibility in clinical guidelines in screening programmes.
The results of this study show that there are differences between barriers and facilitators for SDM when it is applied in the context of healthy people who perform preventive activities, particularly screening, in contrast to general medical consultation contexts.
The authors suggest that to advance in the practice of SDM, we need to develop and disseminate training documents. Further, SDM should be incorporated into clinical guidelines. There should be more studies focusing on healthcare professionals' behaviour within the context of the uncertainty of screening programmes.
探索医疗保健专业人员在实施有关筛查计划的决策支持时的障碍和促进因素。
在 PubMed、Cochrane Library、CINHAL 和 PsycInfo 中进行了系统评价。根据来源，将确定的障碍和促进因素分为三个因素：患者、医疗系统绩效和医疗保健专业人员自身。
共选择了 8 项研究：其中 7 项与癌症筛查有关。最重要的促进因素是对积极参与的文化程度和兴趣，这两者都源于患者。在系统评价中首次确定的最重要障碍是法律冲突、筛查计划中缺乏报酬和临床指南缺乏灵活性。
本研究结果表明，在涉及健康人进行预防活动（特别是筛查）的情况下，SDM 的障碍和促进因素存在差异，与一般医疗咨询背景不同。
作者建议，为了推进决策支持的实践，我们需要制定和传播培训文件。此外，应将决策支持纳入临床指南。应该有更多的研究关注医疗保健专业人员在筛查计划不确定性背景下的行为。
