Sedlakova Jana, Westermair Anna Lisa, Biller-Andorno Nikola, Meier Christoph A, Trachsel Manuel
Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland.
Clinical Ethics Unit, University Hospital of Basel (USB), Basel, Switzerland.
Front Digit Health. 2023 Sep 1;5:1208889. doi: 10.3389/fdgth.2023.1208889. eCollection 2023.
Patient decision aids (PDAs) are important tools to empower patients and integrate their preferences and values in the decision-making process. Even though patients with mental health problems have a strong interest in being more involved in decision making about their treatment, research has mainly focused on PDAs for somatic conditions. In this scoping review, we focus on patients suffering from depression and the role of PDAs for this patient group. The review offers an overview of digital and analog PDAs, their advantages and disadvantages as well as recommendations for further research and development.
A systematic search of the existing literature guided by the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - extension for scoping reviews (PRISMA-ScR) was conducted. Three electronic literature databases with the appropriate thematic focus were searched (PubMed, PsycInfo, and Web of Science). The search strategy used controlled and natural language to search for the key concepts decision aids and depression. The articles were selected in a two-step process guided by predefined inclusion and exclusion criteria. We narratively synthetized information extracted from 40 research articles.
We included 40 articles in our review. Our review revealed that there is more focus on digital PDAs in research than in clinical practice. Digitalization can enhance the benefits of PDAs by developing tools that are more efficient, interactive, and personalized. The main disadvantages of both types of PDAs for the treatment of depression are related to time, dissemination, and capacity building for the health care providers. Digital PDAs need to be regularly updated, effective strategies for their dissemination and acceptance need to be identified, and clinicians need sufficient training on how to use digital PDAs. There is more research needed to study which forms of PDAs are most appropriate for various patient groups (e.g., older adults, or patients with comorbidities), and to identify the most effective ways of PDAs' integration in the clinical workflow. The findings from our review could be well aligned with the International Patient Decision Aids Standards.
More research is needed regarding effective strategies for the implementation of digital PDAs into the clinical workflow, ethical issues raised by the digital format, and opportunities of tailoring PDAs for diverse patient groups.
患者决策辅助工具（PDAs）是增强患者权能并将其偏好和价值观纳入决策过程的重要工具。尽管有心理健康问题的患者对更多地参与其治疗决策有着浓厚兴趣，但研究主要集中在针对躯体疾病的患者决策辅助工具上。在本范围综述中，我们聚焦于抑郁症患者以及患者决策辅助工具对该患者群体的作用。该综述概述了数字和模拟患者决策辅助工具、它们的优缺点以及对进一步研究和开发的建议。
按照《Cochrane系统评价手册》以及《系统评价与Meta分析优先报告条目——范围综述扩展版》（PRISMA-ScR）的指导，对现有文献进行系统检索。检索了三个具有适当主题重点的电子文献数据库（PubMed、PsycInfo和Web of Science）。所使用的检索策略运用了受控语言和自然语言来搜索关键概念“决策辅助工具”和“抑郁症”。文章通过两步法进行筛选，遵循预先定义的纳入和排除标准。我们对从40篇研究文章中提取的信息进行了叙述性综合分析。
我们的综述纳入了40篇文章。我们的综述表明，研究中对数字患者决策辅助工具的关注多于临床实践。数字化可以通过开发更高效、交互式和个性化的工具来增强患者决策辅助工具的益处。这两种类型的患者决策辅助工具在抑郁症治疗方面的主要缺点与时间、传播以及医疗保健提供者的能力建设有关。数字患者决策辅助工具需要定期更新，需要确定有效的传播和接受策略，并且临床医生需要接受关于如何使用数字患者决策辅助工具方面的充分培训。需要更多研究来探讨哪种形式的患者决策辅助工具最适合不同患者群体（例如老年人或患有合并症的患者），并确定将患者决策辅助工具整合到临床工作流程中的最有效方法。我们综述的结果可以很好地与《国际患者决策辅助工具标准》保持一致。
关于将数字患者决策辅助工具有效实施到临床工作流程的策略、数字形式引发的伦理问题以及为不同患者群体量身定制患者决策辅助工具的机会，还需要更多研究。
