共享决策干预在COPD患者中应用效果的Meta分析

Application effectiveness of shared decision-making intervention in patients with chronic obstructive pulmonary disease:a meta-analysis

目的系统评价共享决策干预在慢性阻塞性肺疾病(COPD)患者中的应用效果。方法检索Web of Science、PubMed、The Cochrane Library、Embase、Medline、中国生物医学文献数据库、中国知网、万方数据库、维普数据库中有关共享决策干预在COPD患者中应用效果的随机对照试验,检索时间为建库至2022年4月,并使用RevMan 5.4软件进行Meta分析。结果最终纳入6篇文献,共920例COPD患者。共享决策干预可以降低COPD患者症状恶化再入院率(OR=0.39,95%CI=0.22~0.71,P=0.002)和降低COPD患者急诊就诊率(OR=0.25,95%CI=0.14~0.46,P<0.001),能够改善COPD患者控制情况(P<0.001),提高COPD患者疾病认知度(P<0.001);在一定程度上共享决策干预能够改善COPD患者的生活质量(MD=-7.73,95%CI=-13.23~-2.23,P=0.006)。结论共享决策干预可降低慢性阻塞性肺疾病患者症状恶化再入院率、急诊就诊率,改善COPD控制情况,能够提高COPD患者疾病认知度,并且在一定程度上能够改善COPD患者生活质量。对于研究结果的有效性验证,建议今后研究可以用不同的评估工具进行对比,以评价COPD患者的生活质量,以及开展高质量、大规模研究,进一步探讨共享决策干预对COPD患者的效果。

Objective To systematically evaluate the application effectiveness of shared decision-making intervention in patients with chronic obstructive pulmonary disease(COPD).Methods Randomized controlled trials on the application effectiveness of shared decision-making intervention in patients with COPD were retrieved from Web of Science,PubMed,The Cochrane Library,Embase,Medline,China National Knowledge Infrastructure,Wanfang Database,and VIP Database from the establishment of the databases to April 2022.Meta-analysis was performed using the RevMan 5.4 software.Results A total of 6 articles involving 920 patients with COPD were included.Shared decision-making intervention could reduce the rate of symptom exacerbation readmission in patients with COPD(OR=0.39,95%CI=0.22-0.71,P=0.002)and decrease the rate of emergency department visits(OR=0.25,95%CI=0.14-0.46,P<0.001).It could improve COPD control(P<0.001)and increase disease awareness in patients with COPD(P<0.001).Shared decision-making intervention to some extent could increase the quality of life in patients with COPD(MD=-7.73,95%CI=-13.23 to-2.23,P=0.006).Conclusion Shared decision-making intervention can reduce the rate of symptom exacerbation readmission and emergency department visits,promote COPD control,increase disease awareness,and to some extent,raise the quality of life in patients with COPD.For the validation of research results,future studies are recommended to use different evaluation tools to compare and evaluate the quality of life of patients with COPD,as well as to conduct high-quality,large-scale studies to further explore the effects of shared decision-making intervention in patients with COPD.