Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia.
Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, Brisbane 4006, Australia.
Int J Environ Res Public Health. 2022 Sep 16;19(18):11705. doi: 10.3390/ijerph191811705.
A shared decision-making approach is considered optimal in primary cardiovascular disease (CVD) prevention. Evidence-based patient decision aids can facilitate this but do not always meet patients' health literacy needs. Coronary artery calcium (CAC) scans are increasingly used in addition to traditional cardiovascular risk scores, but the availability of high-quality decision aids to support shared decision-making is unknown. We used an environmental scan methodology to review decision support for CAC scans and assess their suitability for patients with varying health literacy. We systematically searched for freely available web-based decision support tools that included information about CAC scans for primary CVD prevention and were aimed at the public. Eligible materials were independently evaluated using validated tools to assess qualification as a decision aid, understandability, actionability, and readability. We identified 13 eligible materials. Of those, only one qualified as a decision aid, and one item presented quantitative information about the potential harms of CAC scans. None presented quantitative information about both benefits and harms of CAC scans. Mean understandability was 68%, and actionability was 48%. Mean readability (12.8) was much higher than the recommended grade 8 level. Terms used for CAC scans were highly variable. Current materials available to people considering a CAC scan do not meet the criteria to enable informed decision-making, nor do they meet the health literacy needs of the general population. Clinical guidelines, including CAC scans for primary prevention, must be supported by best practice decision aids to support decision-making.
在主要心血管疾病 (CVD) 预防中，采用共同决策方法被认为是最佳选择。基于证据的患者决策辅助工具可以促进这一点，但并不总是满足患者的健康素养需求。除了传统的心血管风险评分外，冠状动脉钙 (CAC) 扫描的应用也越来越广泛，但支持共同决策的高质量决策辅助工具的可用性尚不清楚。我们使用环境扫描方法来审查 CAC 扫描的决策支持，并评估其对不同健康素养患者的适用性。我们系统地搜索了可免费获得的、包含有关 CAC 扫描的主要 CVD 预防信息且面向公众的基于网络的决策支持工具。使用经过验证的工具独立评估合格材料，以评估其是否符合决策辅助工具的资格、可理解性、可操作性和可读性。我们确定了 13 项符合条件的材料。其中，只有一项符合决策辅助工具的标准，有一项介绍了 CAC 扫描潜在危害的定量信息。没有任何一项同时介绍了 CAC 扫描的益处和危害的定量信息。平均可理解性为 68%，可操作性为 48%。平均可读性（12.8）远高于推荐的 8 级水平。用于 CAC 扫描的术语变化很大。目前人们在考虑 CAC 扫描时可获得的材料不符合做出明智决策的标准，也不符合一般人群的健康素养需求。包括 CAC 扫描用于初级预防在内的临床指南，必须辅以最佳实践决策辅助工具来支持决策。
