决策辅助在慢性阻塞性肺疾病患者中应用效果的Meta分析

Application Effect of Decision Aid in Patients with Chronic Obstructive Pulmonary Disease:a Meta-analysis

目的通过Meta分析探讨决策辅助在慢性阻塞性肺疾病(COPD)患者中的应用效果。方法计算机检索PubMed、Web of Science、Embase、CIHNAL、Cochrane Library、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普网中公开发表的关于决策辅助在COPD患者中应用效果的文献,检索时限为建库至2023年2月。由2名经过循证培训的研究小组成员按照纳入与排除标准筛选文献,并进行资料提取。采用Cochrane偏倚风险评价工具对纳入的随机对照试验(RCT)进行质量评价,采用澳大利亚乔安娜布里格斯研究所(JBI)循证卫生保健中心的评价工具对纳入的类实验研究(CCT)进行质量评价。采用RevMan 5.3软件进行Meta分析。结果经筛选最终纳入Meta分析的文献有6篇,其中中文2篇、英文4篇,RCT 4篇、CCT 2篇,共涉及843例患者。纳入的4篇RCT的质量均为B级,纳入的2篇CCT的各条目评价结果均为“是”。Meta分析结果显示:WILSON等、AKL等研究均显示,决策辅助干预后决策冲突量表(DCS)评分低于决策辅助干预前〔均数差(MD)=0.90,95%CI(0.34,1.46),P<0.01;MD=1.30,95%CI(0.83,1.77),P<0.01〕。决策辅助组与对照组生活质量评分比较,差异无统计学意义〔标准化均数差(SMD)=-0.19,95%CI(-0.54,0.16),P=0.29〕。SLOK等、COLLINSWORTH等研究均显示,决策辅助组与对照组再入院率比较,差异无统计学意义〔RR=1.11,95%CI(0.91,1.35),P=0.87;RR=1.46,95%CI(0.91,2.32),P=0.15〕。结论决策辅助可有效降低COPD患者DCS评分,提高决策质量,但其在提高患者生活质量、降低再入院率方面的效果欠佳。

Objective To explore the application effect of decision aid in patients with chronic obstructive pulmonary disease(COPD)through meta-analysis.Methods A computer search was conducted for published literature on the application effect of decision aid in COPD patients in PubMed,Web of Science,Embase,CIHNAL,Cochrane Library,CBM,CNKI,Wanfang Data and VIP.The search time limit was from the establishment of the database to February 2023.Two evidence-based trained research team members screened literature based on inclusion and exclusion criteria and extracted data.Cochrane bias risk assessment tool was used to evaluate the quality of the included randomized controlled trial(RCT),and the evaluation tool of Joanna Briggs Institute(JBI)Evidence-Based Health Care Center in Australia was used to evaluate the quality of the included controlled clinical trail(CCT).Meta-analysis was conducted using RevMan 5.3 software.Results After screening,6 articles were ultimately included in the meta-analysis,including 2 in Chinese,4 in English,4 in RCT,and 2 in CCT,involving a total of 843 patients.The quality of the four RCTs included was grade B;the results of each evaluation item of the 2 CCTs included were"yes".The results of meta-analysis showed that:WILSON et al.and AKL et al.showed that the Decisional Conflict Scale(DCS)score after decision aid intervention was lower than that before decision aid intervention[mean difference(MD)=0.90,95%CI(0.34,1.46),P<0.01;MD=1.30,95%CI(0.83,1.77),P<0.01].There was no significant difference in quality of life scores between the decision aid group and the control group[standardized mean difference(SMD)=-0.19,95%CI(-0.54,0.16),P=0.29].SLOK et al.and COLLINSWORTH et al.showed that there was no statistically significant difference in the readmission rate between the decision aid group and the control group[RR=1.11,95%CI(0.91,1.35),P=0.87;RR=1.46,95%CI(0.91,2.32),P=0.15].Conclusion Decision aid can effectively reduce DCS score and improve decision quality in COPD patients,but it is not effective in improving patients'quality of life and reducing readmission rate.