Fattori Francesco, O'Donnell Deirdre, Rodríguez-Martín Beatriz, Kroll Thilo
School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
Faculty of Health Sciences, University of Castilla-La Mancha, Toledo, Spain.
HRB Open Res. 2020 Nov 23;2:19. doi: 10.12688/hrbopenres.12932.2. eCollection 2019.
Shared decision-making (SDM) is a dialogical relationship where the physician and the patient define the problem, discuss the available options according to the patient's values and preferences, and co-construct the treatment plan. Undertaking SDM in a clinical setting with patients who have limited, impaired or fluctuating cognitive capacity may prove challenging. Supported (defined "Assisted" in the Irish context) decision-making describes how people with impaired or fluctuating capacity remain in control of their healthcare-related choices through mechanisms which build and maximise capacity. Supported and assisted decision-making (ADM) within healthcare settings is theoretically and practically novel. Therefore, there is a knowledge gap about the validity of psychometric instruments used to assess ADM and its components within clinical settings. This systematic review aims to identify and characterise instruments currently used to assess shared, supported and assisted healthcare decision-making between patients with limited, impaired or fluctuating capacity, their family carers and healthcare professionals. A systematic review and narrative synthesis will be performed using a search strategy involving the following databases (PubMed, Cinahl, Embase, Web of Science, Scopus and PsycINFO). Quantitative studies published in the last decade and describing psychometric instruments measuring SDM, supported decision-making and ADM with people having limited or fluctuating capacity will be considered eligible for inclusion. Title and abstract screening will be followed by full-text eligibility screening, data extraction, synthesis and analysis. This review will be structured and reported according to the PRISMA checklist. The COSMIN Risk of bias checklist will be used to assess the quality of the instruments. The results will inform and be useful to HCPs and policymakers interested in having updated knowledge of the available instruments to assess SDM, supported and assisted healthcare decision-making between patients who have impaired or fluctuating capacity, their family carers and healthcare professionals. PROSPERO CRD42018105360; registered on 10/08/2018.
共同决策（SDM）是一种对话关系，在此过程中医生和患者确定问题，根据患者的价值观和偏好讨论可用的选择，并共同制定治疗方案。在临床环境中，与认知能力有限、受损或波动的患者进行共同决策可能具有挑战性。支持性决策（在爱尔兰语境中定义为“协助性决策”）描述了能力受损或波动的人如何通过建立和最大化能力的机制来掌控与其医疗保健相关的选择。医疗环境中的支持性和协助性决策（ADM）在理论和实践上都是新颖的。因此，对于用于评估临床环境中ADM及其组成部分的心理测量工具的有效性存在知识空白。本系统评价旨在识别和描述目前用于评估能力有限、受损或波动的患者与其家庭照顾者及医疗专业人员之间的共同、支持性和协助性医疗决策的工具。将使用涉及以下数据库（PubMed、Cinahl、Embase、科学网、Scopus和PsycINFO）的检索策略进行系统评价和叙述性综合分析。过去十年中发表的描述测量共同决策、支持性决策和ADM的心理测量工具且针对能力有限或波动人群的定量研究将被视为符合纳入标准。标题和摘要筛选之后将进行全文合格性筛选、数据提取、综合和分析。本评价将根据PRISMA清单进行构建和报告。将使用COSMIN偏倚风险清单来评估工具的质量。研究结果将为有兴趣更新关于评估共同决策、支持性和协助性医疗决策的可用工具知识的医疗保健专业人员和政策制定者提供信息并具有参考价值。国际前瞻性系统评价注册库编号CRD42018105360；于2018年8月10日注册。
