Lui Bing Chun, Jerosch-Herold Christina
Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK.
Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norfolk, UK.
Hand Ther. 2024 Dec;29(4):145-160. doi: 10.1177/17589983241278746. Epub 2024 Aug 29.
Carpal tunnel syndrome is a common condition, but some controversies remain regarding diagnostics and the most effective treatments. As a result, patients often experience decisional conflicts, especially when considering carpal tunnel release surgery. Understanding factors that influence decision-making in surgery can help clinicians better grasp patient treatment preferences and priorities, reducing decisional conflicts, and enabling patients to make informed, value-aligned choices through shared decision-making. This qualitative evidence synthesis aims to explore patient perceptions of carpal tunnel release, examine the decision-making factors, and critically appraise and synthesise the existing evidence.
A systematic search was conducted across four electronic databases (MEDLINE, EMBASE, CINAHL Ultimate, PsycINFO) from inception to August 2023, supplemented by referencing and citation searching to identify eligible qualitative studies. Thematic synthesis was adopted as synthesis methodology, involving a line-by-line coding of the primary study findings, and the development of descriptive and analytical themes. Quality appraisal was conducted using the modified Critical Appraisal Skills Programme checklist, supplemented with the COnsolidated criteria for REporting Qualitative research checklist.
Synthesis of six qualitative studies encompassing 66 participants generated five analytical themes: (1) Journey to normalcy, (2) Patient-centred care, (3) Work and life considerations, (4) Weighing up alternatives, and (5) Shaping the expectations, highlighting the complexity of patient decision-making in carpal tunnel release.
In the management of carpal tunnel syndrome, therapists should consider various decision-making factors, prioritising communication and shared decision-making. This, along with personalised interactions, achieves patient-centred care and enhances patient care quality and therapeutic alliance.
腕管综合征是一种常见病症，但在诊断和最有效治疗方法方面仍存在一些争议。因此，患者常常面临决策冲突，尤其是在考虑腕管松解手术时。了解影响手术决策的因素有助于临床医生更好地把握患者的治疗偏好和优先事项，减少决策冲突，并通过共同决策使患者能够做出明智的、符合价值观的选择。本定性证据综合分析旨在探讨患者对腕管松解术的看法，审视决策因素，并对现有证据进行批判性评估和综合分析。
对四个电子数据库（MEDLINE、EMBASE、CINAHL Ultimate、PsycINFO）从建库至2023年8月进行系统检索，并辅以参考文献和引文检索，以确定符合条件的定性研究。采用主题综合分析法作为综合方法，包括对主要研究结果进行逐行编码，以及制定描述性和分析性主题。使用修改后的批判性评估技能计划清单进行质量评估，并辅以定性研究报告的统一标准清单。
对六项定性研究（涉及66名参与者）的综合分析产生了五个分析主题：（1）恢复正常之旅，（2）以患者为中心的护理，（3）工作和生活考量，（4）权衡替代方案，以及（5）塑造期望，突出了腕管松解术中患者决策的复杂性。
在腕管综合征的管理中，治疗师应考虑各种决策因素，将沟通和共同决策放在首位。这与个性化互动相结合，可实现以患者为中心的护理，并提高患者护理质量和治疗联盟。
