School of Nursing, 2358University of Virginia, USA.
Health Sciences Library, 2358University of Virginia, USA.
Dementia (London). 2023 May;22(4):875-909. doi: 10.1177/14713012231156976. Epub 2023 Feb 20.
Evidence supports that older adults with cognitive impairment can reliably communicate their values and choices, even as cognition may decline. Shared decision-making, including the patient, family members, and healthcare providers, is critical to patient-centered care. The aim of this scoping review was to synthesize what is known about shared decision-making in persons living with dementia. A scoping review was completed in PubMed, CINAHL, and Web of Science. Keywords included content areas of dementia and shared decision-making. Inclusion criteria were as follows: description of shared or cooperative decision making, cognitively impaired patient population, adult patient, and original research. Review articles were excluded, as well as those for which the formal healthcare provider was the only team member involved in the decision-making (e.g., physician), and/or the patient sample was not cognitively impaired. Systematically extracted data were organized in a table, compared, and synthesized. The search yielded 263 non-duplicate articles that were screened by title and abstract. Ninety-three articles remained, and the full text was reviewed; 32 articles were eligible for this review. Studies were from across Europe ( = 23), North America ( = 7), and Australia ( = 2). The majority of the articles used a qualitative study design, and 10 used a quantitative study design. Categories of similar shared decision-making topics emerged, including health promotion, end-of-life, advanced care planning, and housing decisions. The majority of articles focused on shared decision-making regarding health promotion for the patient ( = 16). Findings illustrate that shared decision-making requires deliberate effort and is preferred among family members, healthcare providers, and patients with dementia. Future research should include more robust efficacy testing of decision-making tools, incorporation of evidence-based shared decisionmaking approaches based on cognitive status/diagnosis, and consideration of geographical/cultural differences in healthcare delivery systems.
证据表明，即使认知能力下降，有认知障碍的老年人也可以可靠地表达他们的价值观和选择。共同决策，包括患者、家庭成员和医疗保健提供者，对以患者为中心的护理至关重要。本范围综述的目的是综合了解痴呆症患者共同决策的情况。在 PubMed、CINAHL 和 Web of Science 中完成了范围综述。关键词包括痴呆症和共同决策的内容领域。纳入标准如下：描述共同或合作决策、认知障碍患者人群、成年患者和原始研究。排除综述文章，以及正式医疗保健提供者是唯一参与决策的团队成员的文章（例如，医生），和/或患者样本没有认知障碍。系统提取的数据被组织在一个表格中，进行比较和综合。搜索产生了 263 篇非重复文章，通过标题和摘要进行了筛选。93 篇文章仍然存在，并对全文进行了审查；32 篇文章符合本综述的条件。研究来自欧洲（=23）、北美（=7）和澳大利亚（=2）。大多数文章采用定性研究设计，10 篇采用定量研究设计。类似的共同决策主题类别出现，包括促进健康、临终关怀、高级护理计划和住房决策。大多数文章都集中在与患者的健康促进相关的共同决策上（=16）。研究结果表明，共同决策需要精心努力，并且在家庭成员、医疗保健提供者和痴呆症患者中更受欢迎。未来的研究应包括对决策工具进行更有力的疗效测试，根据认知状态/诊断纳入基于循证的共同决策方法，并考虑医疗保健提供系统的地理/文化差异。
