国内外医患共享决策评估工具的系统综述

The Development of Evaluation Tools for Shared Decision Making at Home and Abroad:a Systematic Review

背景医患共享决策(SDM)是基于最佳临床证据,结合患者的个人偏好、价值观联合进行决策的过程。SDM评估工具的开发和应用对促进临床SDM的实践具有重要意义,目前SDM评估工具在国外已有成熟发展,国内相关研究尚处于起步阶段。目的在已有系统综述基础上,对国内外有关SDM评估工具进行系统梳理及更新,为我国有关人员在不同临床条件下选用及开发SDM评估工具提供参考。方法于2019年1月系统检查PubMed(2017年9月—2018年12月)及中国知网、万方数据知识服务平台、维普网(建库至2019年1月)中与SDM评估工具相关的文献,获取与SDM评估工具的基本特征及信效度相关心理测量特性等信息。结果检索到符合标准文献12篇,包括15个评估工具,结合之前SDM相关评估工具的系统综述总结的50个工具和1个观察患者参与医疗决策量表(OPTION)工具网站发现的工具,共66个SDM评估工具,根据工具应用对象不同,可分为患者视角(46个)、医生视角(4个)、观察者视角(13个)及多视角(3个)的评估工具。其中患者视角的SDM评估工具的内容维度包括患者参与决策前、患者参与决策过程、患者参与决策后,医生视角的SDM评估工具包括医生评价患者参与决策和医生在医疗决策中的满意度,观察者视角的SDM评估工具是第三方对医生决策和患者参与决策的评价,多视角评估工具是从医生、患者或观察者中至少两方的视角对同一个决策过程的患者参与决策程度进行评价。结论随着患者参与临床决策不断受到关注和重视,我国学者引进或构建SDM评估工具的研究呈上升趋势,立足于多个视角的SDM评估工具构建及汉化需进一步受到重视。

Background Shared decision making(SDM)is a decision-making process based on the best clinical evidence and combined with patients'preferences and values.The development and application of SDM evaluation tools is of great significance to promote the practice of SDM clinically.The SDM evaluation tools have been developed maturely abroad,while related research at home is still in its infancy.Objective To review and update systematically relevant SDM evaluation tools at home and abroad based on the existing systematic reviews,in order to provide a reference for the practice and development of SDM evaluation tools under different clinical conditions in China.Methods In January 2019,a systematic search was conducted to retrieve the relevant literature of SDM evaluation tools in PubMed database from September of 2017 to December of 2018,and CNKI database,CQVIP database and Wanfang data database before January of 2019.The basic characteristics and psychometric characteristics of SDM evaluation tools related to reliability and validity were extracted.Results Twelve articles conforming to the standard were retrieved including 15 evaluation tools.There were total 66 SDM evaluation tools combined with 50 evaluation tools which had been extracted from the previous systematic reviews and one tool which was found on the website of Observer OPTION Instrument.According to the application object,66 evaluation tools were divided into the tools of patient's perspective(46),doctor's perspective(4),observer's perspective(13)and multiple perspectives(3).Among them,the contentdimension of SDM assessment tool from patient's perspective includes before,during and after patients'participation in decision-making,SDM assessment tool from doctor's perspective includes doctor's evaluation of patient's participation in decision-making and doctor's satisfaction in medical decision-making,SDM assessment tool from observer's perspective is a third-party evaluation of doctor's decision-making and patient's participation in decisionmaking,multi-perspective SDM assessment tool is to evaluate the degree of patients'participation in decision-making from the at least two perspectives of doctors,patients or observers.Conclusion As the increasing attention of patient's participation in clinical decision-making,the researches of the introduction or construction of SDM evaluation tools in China are now on the rise.The construction and localization of SDM evaluation tools based on multiple perspectives needs further attention.