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计算机决策辅助工具在慢性病患者共同决策中的有效性:系统评价和荟萃分析。

Effectiveness of computerised decision aids for patients with chronic diseases in shared decision-making: A systematic review and meta-analysis.

机构信息

School of Nursing, China Medical University, Taichung, Taiwan.

Department of Nursing, China Medical University Hospital, Taichung, Taiwan.

出版信息

J Clin Nurs. 2024 Jul;33(7):2732-2754. doi: 10.1111/jocn.17095. Epub 2024 Mar 29.

Abstract

AIMS

To synthesise the composition and effectiveness of computer-based patient decision aid (PDAs) in interventions for patients with chronic diseases.

DESIGN

A systematic review with meta-analysis.

METHODS

Five databases were searched, and only randomised controlled trials (RCTs)were included. This review was conducted with the PRISMA guidelines. The JBI Appraisal Tools for randomised trials were used to assess the risk of bias. We used the random-effects model to conduct meta-analyses. Evidence from RCTs was synthesised using standardised mean differences or mean differences. The GRADE system was employed to assess the certainty of evidence and recommendations. This study was registered on PROSPERO (number: CRD42022369340).

DATA SOURCES

PubMed, Embase, Web of Science, CINAHL and Cochrane Library were searched for studies published before October 2022.

RESULTS

The review included 22 studies, and most computer-based PDAs reported information on the disease, treatment options, pros and cons and risk comparison and value clarification. The use of computer-based PDAs showed a significant effect on decision conflict and knowledge, but not on decision regret, satisfaction, self-efficacy, anxiety and quality of life. The overall GRADE certainty of evidence was low.

CONCLUSION

Although the quality of evidence was low, however, using computer-based PDAs could reduce decision conflict and enhance knowledge when making medical decisions. More research is needed to support the contention above.

RELEVANCE TO CLINICAL PRACTICE

Computer-based PDAs could assist health-care providers and patients in the shared decision-making process and improving the quality of decision-making.

REPORTING METHOD

This study adhered to PRISMA guidelines. NO PATIENT OR PUBLIC CONTRIBUTION.

摘要

目的

综合基于计算机的患者决策辅助(PDA)在慢性病患者干预措施中的组成和效果。

设计

系统评价和荟萃分析。

方法

搜索了五个数据库,仅纳入随机对照试验(RCT)。本综述遵循 PRISMA 指南进行。使用 JBI 随机试验评估工具评估偏倚风险。我们使用随机效应模型进行荟萃分析。使用标准化均数差或均数差综合 RCT 证据。使用 GRADE 系统评估证据和建议的确定性。本研究在 PROSPERO 上注册(编号:CRD42022369340)。

数据来源

在 PubMed、Embase、Web of Science、CINAHL 和 Cochrane Library 中搜索截至 2022 年 10 月之前发表的研究。

结果

综述纳入了 22 项研究,大多数基于计算机的 PDA 报告了疾病、治疗选择、优缺点以及风险比较和价值澄清方面的信息。使用基于计算机的 PDA 在决策冲突和知识方面显示出显著效果,但在决策后悔、满意度、自我效能、焦虑和生活质量方面没有效果。证据的总体 GRADE 确定性为低。

结论

尽管证据质量较低,但使用基于计算机的 PDA 可以在做出医疗决策时减少决策冲突并增强知识。需要更多的研究来支持上述观点。

临床相关性

基于计算机的 PDA 可以帮助医疗保健提供者和患者共同参与决策过程并提高决策质量。

报告方法

本研究遵循 PRISMA 指南。无患者或公众参与。

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