决策辅助对骨科择期手术影响的Meta分析

Influence of decision aid on orthopedic elective surgery:a Meta-analysis

目的:系统回顾已发表的骨科择期手术决策辅助的随机对照试验,评估决策辅助对骨科病人手术决策的影响。方法:计算机检索PubMed、the Cochrane Library、EMbase、Scopus、万方数据库、中国知网,并对纳入文献的参考文献进行追踪。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果:最终纳入7篇文献。Meta分析结果显示,决策辅助对手术率的影响无统计学意义[RR=0.96,95%CI(0.84,1.10),P=0.58],但是能提高病人满意度[RR=1.21,95%CI(1.01,1.44),P=0.04],减少病人的决策冲突[RR=0.53,95%CI(0.38,0.73),P=0.0001]。结论:在医患关系紧张、医疗资源相对不足的大背景下,决策辅助可以将医患沟通做到实处,提高病人满意度,减少决策冲突率,合理配置医疗资源。

Objective:To systematically review published randomized controlled trials of decision aid in orthopaedic elective surgery and evaluate the effect of decision aid on surgical decision making in orthopaedic patients.Methods:PubMed,the Cochrane Library,EMbase,Scopus,WanFang Database and CNKI were searched,and the references of the included literatures were tracked.Two researchers independently screened the literature,extracted data,and assessed the risk of bias in the included studies.RevMan 5.4 software was used for Meta-analysis.Results:A total of 7 articles were included.The results of Meta-analysis showed that decision aid had no statistical significance on the operation rate(RR=0.96,95%CI 0.84-1.10,P=0.58),but it could improve patient satisfaction(RR=1.21,95%CI 1.01-1.44,P=0.04)and reduce the decision conflict rate of patients(RR=0.53,95%CI 0.38-0.73,P=0.0001).Conclusion:Under the background of tense doctor-patient relationship and insufficient medical resources,decision aid can make doctor-patient communication effective,improve patient satisfaction,reduce decision conflict rate,and rationally allocate medical resources.