The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
J Med Internet Res. 2023 Mar 14;25:e37953. doi: 10.2196/37953.
Increasing prenatal screening options and limited consultation time have made it difficult for pregnant women to participate in shared decision-making. Interactive digital decision aids (IDDAs) could integrate interactive technology into health care to a facilitate higher-quality decision-making process.
The objective of this study was to assess the effectiveness of IDDAs on pregnant women's decision-making regarding prenatal screening.
We searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, World Health Organization International Clinical Trials Registry Platform, Google Scholar, and reference lists of included studies until August 2021. We included the randomized controlled trials (RCTs) that compared the use of IDDAs (fulfilling basic criteria of International Patient Decision Aid Standards Collaboration and these were interactive and digital) as an adjunct to standard care with standard care alone and involved pregnant women themselves in prenatal screening decision-making. Data on primary outcomes, that is, knowledge and decisional conflict, and secondary outcomes were extracted, and meta-analyses were conducted based on standardized mean differences (SMDs). Subgroup analysis based on knowledge was performed. The Cochrane risk-of-bias tool was used for risk-of-bias assessment.
Eight RCTs were identified from 10,283 references, of which 7 were included in quantitative synthesis. Analyses showed that IDDAs increased knowledge (SMD 0.58, 95% CI 0.26-0.90) and decreased decisional conflict (SMD -0.15, 95% CI -0.25 to -0.05). Substantial heterogeneity in knowledge was identified, which could not be completely resolved through subgroup analysis.
IDDAs can improve certain aspects of decision-making in prenatal screening among pregnant women, but the results require cautious interpretation.
不断增加的产前筛查选择和有限的咨询时间使得孕妇难以参与共同决策。交互式数字决策辅助工具（IDDA）可以将交互技术融入医疗保健中，以促进更高质量的决策过程。
本研究旨在评估 IDDA 对孕妇进行产前筛查决策的效果。
我们检索了 Cochrane 对照试验中心注册库、MEDLINE、Embase、PsycINFO、世界卫生组织国际临床试验注册平台、Google Scholar 以及纳入研究的参考文献，检索截至 2021 年 8 月。我们纳入了比较 IDDA（符合国际患者决策辅助工具标准合作组织的基本标准，即具有交互性和数字化）作为标准护理辅助手段与单独使用标准护理，且让孕妇自己参与产前筛查决策的随机对照试验（RCT）。提取了主要结局（即知识和决策冲突）和次要结局的数据，并进行了基于标准化均数差（SMD）的荟萃分析。根据知识进行了亚组分析。使用 Cochrane 偏倚风险工具进行偏倚风险评估。
从 10283 篇参考文献中确定了 8 项 RCT，其中 7 项被纳入定量综合分析。分析结果表明，IDDA 提高了知识（SMD 0.58，95%CI 0.26-0.90），降低了决策冲突（SMD-0.15，95%CI-0.25 至-0.05）。知识方面存在显著的异质性，无法通过亚组分析完全解决。
IDDA 可以改善孕妇产前筛查决策的某些方面，但结果需要谨慎解释。
