针对约50岁女性乳腺癌筛查的决策辅助工具：随机对照试验的系统评价和荟萃分析

Decision aids for breast cancer screening in women approximately 50 years of age: A systematic review and meta-analysis of randomised controlled trials.

作者信息

Yu Lin, Yang Shu, Zhang Chunmiao, Guo Pingping, Zhang Xuehui, Xu Mengmeng, Tian Qi, Cui Xuan, Zhang Wei, Fan Shuang

机构信息

School of Nursing, Jilin University, Changchun, China.

The Second Hospital of Jilin University, Changchun, China.

出版信息

J Clin Nurs. 2021 Nov 4. doi: 10.1111/jocn.16112.

DOI:10.1111/jocn.16112

PMID:34738288

Abstract

AIMS AND OBJECTIVES

Review the content, quality and effect of breast cancer screening decision aids (BCS-DAs) in women approximately 50 years of age to provide a basis for the development of DAs.

BACKGROUND

Breast cancer screening (BCS) decisions are complex and should vary depending on a woman's risk of breast cancer and her values and preferences. Decision aids (DAs) can help support women and medical staff in shared decision-making (SDM) when solving BCS problems.

DESIGN

Systematic review and meta-analysis.

METHODS

Four databases were searched starting at the time of establishment of the database to March 2021. The PRISMA checklist was followed. The meta-analysis was carried out using Review Manager 5.3 software. The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook. The quality of the DAs was assessed using the International Standards for Decision Aid (IPDASi v4.0).

RESULTS

The search strategy obtained 2024 references. After abstraction and full text screening, a total of seven studies were included. This article systematically reviews the content, quality and effectiveness of DAs in seven RCTs in helping women to make BCS decisions. The DAs were mostly in paper or online form and displayed disease screening information, analysed the benefits and harms of options and clarified the value to patients. Among all the DAs, only one met the minimum quality standards of IPDASi v4.0. Comprehensive analysis shows that DAs can significantly improve knowledge and increase the proportion of women who make informed choices, but they have no effect on screening attitude, intention, decision conflict or regret.

CONCLUSIONS

In the future, nurses should be encouraged to develop DAs in accordance with strict standards and to make them applicable to young women of different backgrounds.

RELEVANCE TO CLINICAL PRACTICE

The result may be provide a basis for the development of DAs to promote women's informed screening choices.

摘要

目的与目标

回顾针对约50岁女性的乳腺癌筛查决策辅助工具（BCS-DAs）的内容、质量及效果，为决策辅助工具的开发提供依据。

背景

乳腺癌筛查（BCS）决策复杂，应根据女性患乳腺癌的风险及其价值观和偏好而有所不同。决策辅助工具（DAs）在解决BCS问题时，可帮助支持女性和医务人员进行共同决策（SDM）。

设计

系统评价与荟萃分析。

方法

从数据库建立之时至2021年3月，检索了四个数据库。遵循PRISMA清单。使用Review Manager 5.3软件进行荟萃分析。采用Cochrane手册推荐的偏倚风险工具评估研究质量。使用国际决策辅助标准（IPDASi v4.0）评估决策辅助工具的质量。

结果

检索策略共获得2024篇参考文献。经过摘要和全文筛选，共纳入7项研究。本文系统评价了7项随机对照试验中决策辅助工具在帮助女性做出BCS决策方面的内容、质量和有效性。决策辅助工具大多为纸质或在线形式，展示疾病筛查信息，分析各选项的利弊，并向患者阐明价值。在所有决策辅助工具中，只有一项符合IPDASi v4.0的最低质量标准。综合分析表明，决策辅助工具可显著提高知识水平，增加做出明智选择的女性比例，但对筛查态度、意愿、决策冲突或遗憾没有影响。