摘要
目的 系统评价决策辅助工具(PDA)在糖尿病患者管理中的应用效果,归纳其研发的核心要素、应用流程、形式等.方法 于2024年1月,计算机检索PubMed、Web of Science、CINAHL、Cochrane Library、Embase、PsycINFO、Scopus,获取与糖尿病患者PDA有关的随机对照试验,检索时限均为建库至2023年12月31日.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,并采用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糖尿病患者PDA的核心要素、临床应用流程,系统评价其临床应用效果.结果 最终纳入10篇文献,内容涉及他汀类药物选择、糖尿病药物选择决策、糖尿病治疗决策、个体化决策、个性化自我管理目标设定等决策主题.10篇文献总体质量中等,其中1篇为A级、9篇为B级.由定性分析可知,现阶段患者PDA核心内容包括信息支持、方案利弊分析、患者价值澄清3个方面,总结实施流程分为7个阶段;患者PDA形式多样,对于糖尿病患者的知识水平、决策冲突、决策参与水平、自我效能、风险感知水平方面存在影响,在血糖控制水平和依从性方面的效果尚未得到证实.结论 糖尿病患者的PDA作为促进共享决策的有效手段,有助于提高患者知识水平、决策冲突、决策参与水平、自我效能、风险感知水平,未来应开发更多适用于我国患者的PDA.
Abstract
Objective To systematically review the effect of patient decision aids(PDA)in the management of diabetes patients,and summarize the core elements,application process,forms of its research and development.Methods In January 2024,randomized controlled trials(RCTs)on PDA in diabetes patients were electronically searched in PubMed,Web of Science,CINAHL,Cochrane Library,Embase,PsycINFO and Scopus.Two researchers independently screened literature based on inclusion criteria and extracted data,and used the Cochrane Risk of Bias(version 5.1.0)for literature quality evaluation.Descriptive analysis was used to analyze the core elements and application process of diabetes patients'PDA,and systematically evaluate its clinical effect.Results A total of 10 articles were included,including statin drug selection decision,diabetes drug selection decision,diabetes treatment decision,individualized decision,personalized self-management goal setting and other decision topics.The overall quality of the 10 articles was moderate,with one article rated as A and nine articles rated as B.According to qualitative analysis,the core content of patient PDA involved three aspects of information support,analysis of the pros and cons of the plan,and clarification of patient value,and the implementation process was summarized into seven stages.There were various forms of patient PDA,which had an impact on diabetes patients'knowledge,decision conflict,decision participation,self-efficacy,and risk perception,and the effect on blood glucose management and compliance had not yet been confirmed.Conclusions As an effective means to promote shared decision-making,diabetes patients'PDA can help improve patients'knowledge,decision conflict,decision participation,self-efficacy,and risk perception.Numerous PDAs suitable for Chinese patients should be developed.
维普
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