中医临床实践指南整合患者价值观与偏好的思路与方法学探析

Thought and Methodology of Integrating Patients Values and Preferences in Clinical Practice Guidelines of Traditional Chinese Medicine

患者价值观与偏好是研发临床实践指南(以下简称“指南”)的重要依据,影响着推荐意见在真实世界中的实施效果。中医强调以人为本,在辨病辨证过程中涵盖患者价值观与偏好(PVAP)的因素。将患者价值观与偏好整合入中医指南的研发,既符合循证医学的内在要求,又体现了中医自身的特点。中医临床收集四诊信息、确立理法方药,实际上就是在医患互通信息的共享决策中完成的。基于患者价值观与偏好在中医诊疗中的特殊效用,提出将患者价值观与偏好整合入中医指南,并作为指南中重要版块进行报告。首先,可通过分析国际相关领域现有文献,借鉴PVAP相关研究资料搜集与分类的方法和经验,得到患者价值观与偏好相关循证问题。其次,根据主题目标对提取的信息进行患者价值观与偏好研究证据重组,归纳指南研发纳入的患者价值观与偏好内容、指南结合患者价值观与偏好的思路与模式。最终,结合专家访谈、专家共识构建中医指南整合患者价值观与偏好的体系方法,包括整合的工作程序、实施方法及匹配的方法学工具。该体系的建立可为研发更贴合临床实际情境的中医指南提供指导,并为今后指南制定者整合患者价值观与偏好工作提供助力。

Patient values and preferences(PVAP)is an important part when developing clinical practice guide⁃lines(abbreviated as guidelines),which may influence the implementation of recommendations in the real world.Traditional Chinese Medicine(TCM)emphasizes people-oriented ideas and involves PVAP during the disease and pat⁃tern differentiation.Therefore,integrating PVAP into the research and development of TCM guidelines not only meets the inherent requirements of evidence-based medicine,but also reflects the characteristics of TCM itself.The collec⁃tion of the four examinations and the decisions on principles,methods,formulas,and medicinals in TCM are all founded on shared decision making between doctors and patients.Considering the unique value of PVAP in TCM diag⁃nosis and treatment,this paper proposed the thoughts and methods to integrate PVAP into the development of TCM guidelines and report it as an important section in the guidelines.Firstly,evidence-based issues related to PVAP were obtained through digging the relevant knowledge and experience from the existing international literature in related fields.Secondly,evidence on PVAP from the extracted data was restructured according to the subject,and the con⁃tent,thoughts and model of PVAP used in the development of guidelines were summarized.Finally,after experts sur⁃vey and consensus meeting,the method for integrating PVAP into the development of TCM guidelines was formed,in⁃cluding procedures,implementation method and matching methodological tools.This method will provide reference for the development of TCM guidelines that are more suitable for the actual clinical situation,and help guideline makers to integrate PVAP in the future guideline development.