结直肠疾病诊疗中患者决策辅助工具应用效果的系统评价 postprint

Abstract: Background Patient decision aids (PDA) is an essential tool to assist patients in the process of shared-decision making.However, the effects are inconsistent in shared-decision making in the diagnosis and treatment of colorectal disease .Objective To assess the development factors and clinical application effects of patient decision aids in the colorectal diseases using a systematic review.Methods From establishing the database to January 2022, we retrieved and included randomized controlled trials（RCTs）on colorectal disease patient decision aids in PubMed，Web of Science，CIHNAL，Cochrane Library，Embase，PsycIFO，JBI，SCOPUS，CNKI, Wanfang, VIP and CBM by computer. The RCTs were screened based on inclusive criteria and were evaluated with the Cochrane risk of bias assessment tool （5.1.0） to describe the development factors of patient decision aids and to summarize the effect of the intervention.Results A total of 11 literatures were included referring to clinical decision such as colorectal cancer screening, informed choice, chemotherapy for patients with advanced colorectal cancer,supportive care for metastatic colorectal cancer, and HNPCC risk genes Testing. Among 11 literatures，the overall quality is in the medium level including 1 with level A and 10 with level B. The analysis found that：（1）In present period， development of patient decision aids mainly referred to the quality evaluation criteria published by the International Patient Decision Aids Collaboration，and core content of the tool included information support，advantages and disadvantages analysis of scheme as well as the clarification of patient values；（2）With the support of a patient decision aid，increased patients' knowledge（six studies），reduced decisional conflicts（eight studies）and promoted informed choice（two studies).Conclusions There is still insufficient evidence for the change of decision-making behavior and results of patient decision-making aids in colorectal disease, yet they have broad prospect in clinical practice. Future research can learn from the relevant theoretical achievements of foreign decision aids and combine the characteristics of the Chinese population to develop patients decision aids for colorectal disease with different stages of characteristics, and to further evaluate its effects.