结直肠癌诊疗中患者决策辅助工具应用效果的系统评价  

Effect of Patient Decision Aids in the Diagnosis and Treatment of Colorectal Cancer:a Systematic Review

作　　者：段玉霞 李珍 张斯齐 房志学 秦月兰[4] DUAN Yuxia;LI Zhen;ZHANG Siqi;FANG Zhixue;QIN Yuelan(General Surgical Ward 1,the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People's Hospital),Changsha 410005,China;Geriatric Ward 1,Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410005,China;Orthopedic Ward 2,Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410005,China;Hospital Office,Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410005,China)

机构地区：[1]湖南师范大学附属第一医院(湖南省人民医院)普外一病区,湖南省长沙市410005 [2]湖南省人民医院(湖南师范大学附属第一医院)老年科一病区,湖南省长沙市410005 [3]湖南省人民医院(湖南师范大学附属第一医院)骨科二病区,湖南省长沙市410005 [4]湖南省人民医院(湖南师范大学附属第一医院)院办,湖南省长沙市410005

出　　处：《中国全科医学》2023年第25期3194-3201,共8页Chinese General Practice

基　　金：湖南省卫生健康委课题项目(202314027774,202214023448)。

摘　　要：背景患者决策辅助工具(PDA)是在实施医患共同决策过程中,辅助患者决策的重要工具,然而在结直肠癌的诊疗过程中,其应用效果并不一致。目的系统评价结直肠癌PDA研发的核心要素及临床应用效果。方法于2022年2月,计算机检索PubMed、Web of Science、CINAHL、Cochrane Library、EmBase、PsycINFO、乔安娜布里格斯研究所(JBI)循证卫生保健数据库、Scopus、中国知网、万方数据知识服务平台、维普中文科技期刊全文数据库、中国生物医学文献数据库,获取有关结直肠癌PDA的随机对照试验,检索时限均为建库至2022年1月。由2名研究者独立根据纳入标准逐层筛选文献并提取资料后,采用Cochrane偏倚风险评估工具(5.1.0版)进行文献质量评价。采用描述性分析法分析PDA研发的核心要素,总结其临床应用效果。结果最终纳入11篇文献,文献总体质量中等,其中A级文献1篇,B级文献10篇。11篇文献涉及结直肠癌筛查、晚期结直肠癌患者的系统治疗与支持性照护、转移性结直肠癌化疗、遗传性非息肉病性结直肠癌风险基因检测等临床决策主题。通过分析得知:现阶段结直肠癌PDA的研发主要参照国际患者决策辅助工具标准协作组发布的质量评价标准,工具核心要素包括信息支持、方案利弊分析、患者价值澄清;11篇文献中,4篇文献发现结直肠癌PDA的应用有助于提高患者知识水平,8篇文献发现结直肠癌PDA的运用降低了患者决策冲突水平,2篇文献结果表明结直肠癌PDA的使用促进了知情选择。结论结直肠癌PDA的应用有助于促进决策行为及结果的改善尚缺乏足够的证据支持,但其应用前景十分广阔。未来可以借鉴国外决策辅助相关理论成果,结合我国人群特点,开发出适用于不同疾病阶段的结直肠癌PDA,并进一步评估其在辅助决策中的运用效果。Background Patient decision aids(PDAs)are essential tools to assist patients in the process of shared-decision making.However,their effects have been reported to be inconsistent in shared-decision making in the diagnosis and treatment of colorectal cancer.Objective To assess the core factors in the development of PADs supporting decision-making in colorectal cancer diagnosis and treatment,and their application effects using a systematic review.Methods In February 2022,randomized controlled trials(RCTs)on PDAs supporting decision-making in colorectal cancer care were searched in databases including PubMed,Web of Science,CIHNAL,Cochrane Library,EmBase,PsycINFO,JBI,Scopus,CNKI,WanFang,CQVIP and SinoMed from inception to January,2022.Two researchers performed literature screening and data extraction separately.The Cochrane Collaboration's tool for assessing risk of bias in randomised trials(5.1.0)was used to assess the risk of bias.A descriptive analysis was conducted to describe the core factors used in the development of PDAs and to summarize the effect of PDAs.Results A total of 11 RCTs were included,involving PDAs for supporting decision-making in colorectal cancer screening,systemic therapy and supportive care for advanced colorectal cancer,chemotherapy for metastatic colorectal cancer,and genetic testing for hereditary nonpolyposis colorectal cancer.The quality was moderate on the whole.Specifically,the quality of one RCT was rated as level A and that of the other 10 was level B.The analysis found that:(1)currently,the development of PDAs for supporting decision-making in colorectal cancer is mainly under the guidance of the quality criteria framework published by the International Patient Decision Aids Standards Collaboration,and the core content of the tool include providing information about options,balanced presentation of options,clarifying and expressing values;(2)The use of PDAs increased patient knowledge(six RCTs),reduced patient decisional conflicts(eight RCTs)and promoted informed choice(two RCTs).Co

关 键 词：结直肠癌 结直肠疾病 诊疗模式 共同决策 决策支持技术 患者决策辅助工具 应用效果 系统评价 

分 类 号：R735.34[医药卫生—肿瘤] R395[医药卫生—临床医学] R195[哲学宗教—心理学]