Department of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China.
Department of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
BMJ Open. 2023 Aug 22;13(8):e075239. doi: 10.1136/bmjopen-2023-075239.
The purpose of this scoping review was to synthesise the effectiveness and acceptability of decision aids for critically ill patients and family members in the intensive care unit (ICU).
A systematic search of four electronic databases and grey literature was undertaken to identify relevant studies on the application of decision aids in the ICU, without publication date restriction, through March 2023. The methodological framework proposed by Arksey and O'Malley was used to guide the scoping review.
Fourteen papers were ultimately included in this review. However, only nine decision aids were available, and it is noteworthy that many of these studies focused on the iterative development and testing of individual decision aids. Among the included studies, 92% (n=13) were developed in North America, with a primary focus on goals of care and life-sustaining treatments. The summary of the effect of decision aid application revealed that the most common indicators were the level of knowledge and code status, and some promising signals disappeared in randomised trials.
The complexity of treatment decisions in the ICU exceeds the current capabilities of existing decision aids. There is a clear gap in decision aids that are tailored to different cultural contexts, highlighting the need to expand the scope of their application. In addition, rigorous quality control is very important for randomised controlled trial, and indicators for assessing the effectiveness of decision aids need to be further clarified.
本范围综述旨在综合评估重症监护病房（ICU）中针对危重症患者及其家属的决策辅助工具的有效性和可接受性。
通过 2023 年 3 月之前对四个电子数据库和灰色文献的系统搜索，确定了在 ICU 中应用决策辅助工具的相关研究，未对出版日期进行限制。本综述采用 Arksey 和 O'Malley 提出的方法学框架进行指导。
最终纳入了 14 篇论文。然而，仅有 9 种决策辅助工具可用，值得注意的是，这些研究大多集中于个体决策辅助工具的迭代开发和测试。在纳入的研究中，92%（n=13）来自北美，主要关注于照护目标和生命支持治疗。决策辅助应用效果的总结表明，最常见的指标是知识水平和预设医疗指令，一些有前景的信号在随机试验中消失了。
ICU 中治疗决策的复杂性超出了现有决策辅助工具的现有能力。针对不同文化背景的决策辅助工具存在明显差距，这突显了扩大其应用范围的必要性。此外，随机对照试验的严格质量控制非常重要，需要进一步明确评估决策辅助工具有效性的指标。
