摘要
背景心血管疾病(CVD)严重威胁居民的生命健康,其防治效果在很大程度上依赖科学合理的医疗决策。随着共享决策(SDM)模式的发展,患者决策辅助工具(PDAs)逐渐成为促进医患沟通、提升患者参与度的重要手段。然而,目前心血管领域PDAs的开发质量参差不齐,缺乏统一规范。患者决策辅助工具国际标准(IPDAS 4.0)为PDAs的内容设计与效果评价提供了循证框架。本研究基于IPDAS 4.0标准对心血管领域PDAs进行系统评价,以期为临床实践提供参考。目的评价PDAs在CVD患者SDM中的应用效果。方法系统检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、维普网、中国生物医学文献数据库和万方数据知识服务平台中关于PDAs在CVD患者中应用效果的随机对照试验,检索时限为建库至2023-10-31。由2名研究者独立筛选文献、对纳入文献进行资料提取和质量评价。试验组接受PDAs干预,形式不限;对照组为常规治疗或护理。采用IPDAS 4.0对PDAs的开发质量进行评价,并用RevMan 5.4软件进行Meta分析。结果共纳入16篇文献,包括4861例患者。IPDAS 4.0评价结果显示,得分排名前三的主题是利益冲突声明、健康问题及选项信息、患者价值观相关信息,排名后三的主题是检测类、平易语言、评估。Meta分析显示,试验组较对照组能够提高患者的知识水平(SMD=0.88,95%CI=0.52~1.24,P<0.001),减少患者的决策冲突(SMD=-0.21,95%CI=-0.40~-0.03,P<0.001),具体表现在知情(SMD=-0.36,95%CI=-0.48~-0.25,P<0.001)、价值澄清(SMD=-0.24,95%CI=-0.35~-0.13,P<0.001)、支持(SMD=-0.19,95%CI=-0.31~-0.08,P<0.001)和有效决策(SMD=-0.20,95%CI=-0.31~-0.08,P<0.001)方面。结论PDAs干预在降低决策冲突、提高决策满意度、知识水平方面有效,但对减少患者决策后悔的作用仍需进一步研究。未来需要结合我国医疗现状,基于IPDAS 4.0开发适用于CVD领域的高质量PDAs,推动SDM理念在临床实践中的落实。
Background Cardiovascular disease(CVD)is a major threat to human health,and its prevention and treatment largely depend on evidence-based and rational medical decision-making.With the development of the shared decisionmaking(SDM)model,patient decision aids(PDAs)have increasingly been used to facilitate clinician-patient communication and enhance patient engagement in decision-making.However,the quality of cardiovascular PDAs varies considerably and lacks standardized regulation.The International Patient Decision Aid Standards(IPDAS 4.0)provide an evidence-based framework for the design and evaluation of PDAs.This study systematically evaluated PDAs in the cardiovascular field using the IPDAS 4.0 framework to provide evidence for clinical practice.Objective To evaluate the effectiveness of PDAs in SDM among CVD patients.Methods A systematic search was conducted in PubMed,Embase,Web of Science,Cochrane Library,CNKI,VIP,CBM,and Wanfang Data,covering publications up to October 31,2023.Randomized controlled trials(RCTs)evaluating the effects of PDAs in patients with CVD were included.Two researchers independently screened the studies,extracted data,and assessed methodological quality.Intervention groups received PDAs in any format,while control groups received routine treatment or care.The quality of PDAs development was assessed using IPDAS 4.0,and meta-analysis was performed with RevMan 5.4.Results A total of 16 RCTs involving 4861 patients were included.According to IPDAS 4.0,the top three scoring domains were disclosure,information and values,while the lowest three were test,plain language,and decision support technology evaluation.Meta-analysis indicated that PDAs significantly improved patients'knowledge(SMD=0.88,95%CI=0.52-1.24,P<0.001)and reduced decisional conflict(SMD=-0.21,95%CI=-0.40--0.03,P<0.001).Reductions in decisional conflict were observed across the informed(SMD=-0.36,95%CI=-0.48--0.25,P<0.001),values clarity(SMD=-0.24,95%CI=-0.35--0.13,P<0.001),support(SMD=-0.19,95%CI=-0.31--0.08,P<0.001),and effective decision(SMD=-0.20,95%CI=-0.31--0.08,P<0.001)subscales.Conclusion PDAs interventions are effective in improving knowledge,decisional satisfaction,and reducing decisional conflict among CVD patients,though their impact on decision regret requires further investigation.Future studies should integrate China's healthcare context to develop PDAs tailored to CVD patients based on the IPDAS 4.0 framework,thereby promoting the implementation of SDM in clinical practice.
作者
裴志怡
张晓欣
林佳艺
张向毅
康晓凤
PEI Zhiyi;ZHANG Xiaoxin;LIN Jiayi;ZHANG Xiangyi;KANG Xiaofeng(School of Nursing,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China)
出处
《中国全科医学》
北大核心
2026年第7期945-952,共8页
Chinese General Practice
基金
北京协和医学院2022年中央高校教育教学改革专项资金支持项目(2022zlgc0112)。
关键词
心血管疾病
共同决策
患者决策辅助工具国际标准
决策冲突
META分析
Cardiovascular diseases
Decision making,shared
International Patient Decision Aid Standards
Decisional conflict
Meta-analysis
