决策辅助工具在癌症患者预立医疗照护计划中应用效果的Meta分析

Effect of decision aid tools for advance care planning in patients with cancer:a Meta-analysis

目的系统评价决策辅助工具在癌症患者预立医疗照护计划中的应用效果。方法计算机检索Embase、PubMed、CINAHL、The Cochrane Library、PsycINFO、中国生物医学文献数据库、维普、中国知网、万方数据库中决策辅助工具应用于癌症患者参与预立医疗照护计划的随机对照试验。检索时限为建库至2022年2月23日。2名研究员独立筛选文献、评价文献质量等级、整合数据后,采用RevMan 5.3软件进行Meta分析。结果共纳入13项随机对照试验,包括2151例癌症患者,其中试验组1057例,对照组1094例。Meta分析显示,试验组预立医疗指示文件的签署(OR=1.81,95%CI 1.22~2.69,Z=2.95,P<0.01)、预立医疗照护计划认知得分(MD=0.58,95%CI 0.35~0.81,Z=4.90,P<0.01)均高于对照组,差异有统计学意义;试验组临终前接受心肺复苏治疗(MD=0.33,95%CI 0.21~0.53,Z=4.64,P<0.01)、决策冲突水平(MD=-3.69,95%CI-6.43~-0.95,Z=2.64,P<0.01)均低于对照组,差异有统计学意义。结论现有证据表明,决策辅助工具能够提高癌症患者对预立医疗照护计划的认知,促使其参与预立医疗照护计划讨论并签署预立医疗指示文件,降低患者临终前接受心肺复苏治疗的意愿,减少决策冲突。

Objective To systematically evaluate the effect of decision aid tools for advance care planning(ACP)in patients with cancer.Methods Randomized controlled trials about the effect of decision aid tools for ACP in patients with cancer were retrieved from Embase,PubMed,CINAHL,the Cochrane Library,PsycINFO,Chinese Biomedical Literature Database,VIP,China National Knowledge Internet and Wanfang Data.The retrieval time was from inception to February 23,2022.Literature screening,quality evaluation and data consolidation were carried out independently by two researchers.Then,RevMan 5.3 software was used for Meta analysis.Results A total of 13 researches were included,involving 2151 cancer patients.Meta-analysis showed that the signing of advance directives(OR=1.81,95%CI 1.22-2.69,Z=2.95,P<0.01)and knowledge scores related to ACP(MD=0.58,95%CI 0.35-0.81,Z=4.90,P<0.01)in experimental group was higher than that in control group,but receiving cardiopulmonary resuscitation treatment before death(MD=0.33,95%CI 0.21-0.53,Z=4.64,P<0.01)and the level of decision confliction(MD=-3.69,95%CI-6.43--0.95,Z=2.64,P<0.01)in experimental group was lower than those in control group,and the differences were statistically significant.Conclusions Existing evidence shows that decision aid tools can improve cancer patients′awareness of ACP,help patients to join in ACP discussions and sign advanced directives,reduce patients'preference for cardiopulmonary resuscitation treatment before death and reduce decision-making conflicts.