冠心病诊疗中患者决策辅助工具干预效果的系统评价

Effect of Patient Decision Aids in the Diagnosis and Treatment of Coronary Artery Disease:a Systematic Review

背景患者决策辅助工具(DA)被认为是实现医患共同决策的重要工具,然而在冠心病的诊断和治疗中其干预效果并不明朗。目的评价DA在冠心病诊疗中的应用效果。方法计算机检索PubMed、Web of Science、EMBase、The Cochrane Library数据库,采用主题词和自由词构造检索式,检索自建库至2021年3月发表的使用DA对冠心病患者进行干预的研究文献。依据Cochrane偏倚风险评估工具(RoB2版)进行文献质量评价,提取数据,总结DA的干预效果。结果共纳入文献6篇,文献质量总体中等。4篇文献为近5年研究;5项研究主要来自美国;3项研究为冠心病的治疗方式,3项研究为疑似冠心病的胸痛诊断筛查。结果显示:(1)在6项研究中,2项改变了患者的决策行为,6项提高了患者知识水平,3项降低了患者的决策冲突,2项提高了患者的决策参与程度;(2)DA多以网页版的形式为主,内容包括冠心病相关的信息支持、澄清方案利弊、患者价值判断。结论在冠心病诊疗中,DA的干预效果具有一定局限性,但其在临床仍具有广阔的应用前景。未来应该加强对临床医生的培训,设计出符合患者特征和中国文化背景的决策辅助工具,以促进其临床应用。

Background Patient decision aid is recognized as an essential tool for shared-decision making.However,it is not clear that its role in shared-decision making in the diagnosis and treatment of coronary artery disease(CAD).Objective To assess the effect of patient decision aids in the diagnosis and treatment of CAD using a systematic review.Methods Databases of PubMed,Web of Science,EMBase and The Cochrane Library were searched from inception to March 2021 for randomized trials assessing the effect of patient decision aids used in the diagnosis and treatment of CAD patients using a type of searching algorithm consisting of subject headings and free words.The Cochrane risk-of-bias tool for randomized trials(RoB2)was used for assessing risk of bias.Data were extracted,and effects of patient decision aids were summarized.Results A total of six randomized trials were included,and their qualities were moderate on the whole.Four were published within the past five years;five were conducted in the United States;three focus on the treatment of CAD and another three are about chest pain assessment due to suspected CAD.The effects of patient decision aids were summarized as follows:(1)With the support of a patient decision aid,patients obtained changes in their decision-making behaviors(two studies),increased CAD-related knowledge(all studies),reduced decisional conflicts(three studies),and higher rate of attending decision-making(two studies).(2)Most of the patient decision aids are web-based,and their contents mainly include information related to CAD,clarifying the pros and cons of treatment schemes for CAD,and personal risk assessments.Conclusion The effects of patient decision aids are limited in the diagnosis and treatment of CAD,yet they have broad prospect in clinical practice.To promote their application in China,it is suggested to strengthen relevant trainings for clinicians to develop patient decision aids in line with features of Chinese culture and patients.