Department of Respiratory Sciences, University of Leicester, Leicester, UK
College of Medicine, Biological Sciences & Psychology, National Institute for Health Research (NIHR) Applied Research Collaboration (East Midlands), Leicester, UK.
BMJ Open. 2023 May 2;13(5):e069461. doi: 10.1136/bmjopen-2022-069461.
Shared decision-making (SDM) supports patients to make informed and value-based decisions about their care. We are developing an intervention to enable healthcare professionals to support patients' pulmonary rehabilitation (PR) decision-making. To identify intervention components we needed to evaluate others carried out in chronic respiratory diseases (CRDs). We aimed to evaluate the impact of SDM interventions on patient decision-making (primary outcome) and downstream health-related outcomes (secondary outcome).
We conducted a systematic review using the risk of bias (Cochrane ROB2, ROBINS-I) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) tools.
MEDLINE, EMBASE, PSYCHINFO, CINAHL, PEDRO, Cochrane Central Register of Controlled Trials, the International Clinical Trials Registry Platform Search Portal, ClinicalTrials.gov, PROSPERO, ISRCTN were search through to 11th April 2023.
Trials evaluating SDM interventions in patients living with CRD using quantitative or mixed methods were included.
Two independent reviewers extracted data, assessed risk of bias and certainty of evidence. A narrative synthesis, with reference to The Making Informed Decisions Individually and Together (MIND-IT) model, was undertaken.
Eight studies (n=1596 (of 17 466 citations identified)) fulfilled the inclusion criteria.Five studies included components targeting the patient, healthcare professionals and consultation process (demonstrating adherence to the MIND-IT model). All studies reported their interventions improved patient decision-making and health-related outcomes. No outcome was reported consistently across studies. Four studies had high risk of bias, three had low quality of evidence. Intervention fidelity was reported in two studies.
These findings suggest developing an SDM intervention including a patient decision aid, healthcare professional training, and a consultation prompt could support patient PR decisions, and health-related outcomes. Using a complex intervention development and evaluation research framework will likely lead to more robust research, and a greater understanding of service needs when integrating the intervention within practice.
CRD42020169897.
共同决策（SDM）支持患者对其治疗做出知情和基于价值的决策。我们正在开发一项干预措施，以使医疗保健专业人员能够支持患者的肺康复（PR）决策。为了确定干预措施的组成部分，我们需要评估在慢性呼吸系统疾病（CRD）中进行的其他干预措施。我们的目的是评估 SDM 干预措施对患者决策（主要结果）和下游健康相关结果（次要结果）的影响。
我们使用偏倚风险（Cochrane ROB2、ROBINS-I）和证据确定性（推荐评估、制定和评估分级）工具进行了系统评价。
MEDLINE、EMBASE、PSYCHINFO、CINAHL、PEDRO、Cochrane 对照试验中心注册库、国际临床试验注册平台搜索门户、ClinicalTrials.gov、PROSPERO、ISRCTN 于 2023 年 4 月 11 日进行了检索。
纳入使用定量或混合方法评估 CRD 患者 SDM 干预措施的试验。
两名独立评审员提取数据，评估偏倚风险和证据确定性。采用叙述性综合方法，并参考个体化和共同做出明智决策（MIND-IT）模型。
八项研究（n=1596（从 17466 条引文中确定））符合纳入标准。五项研究包括针对患者、医疗保健专业人员和咨询过程的干预措施组成部分（表明符合 MIND-IT 模型）。所有研究均报告其干预措施改善了患者的决策和健康相关结果。但没有一项结果在所有研究中一致报告。四项研究存在高偏倚风险，三项研究证据质量低。两项研究报告了干预措施的保真度。
这些发现表明，开发包括患者决策辅助工具、医疗保健专业人员培训和咨询提示在内的 SDM 干预措施，可以支持患者的 PR 决策和健康相关结果。使用复杂的干预措施开发和评估研究框架可能会导致更强大的研究，并在将干预措施整合到实践中时更好地了解服务需求。
PROSPERO 注册号：CRD42020169897。
