系统回顾急诊科促进共同决策的障碍、促进因素和工具。

IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE
Academic Emergency Medicine Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI:10.1111/acem.14998
Dirk T Ubbink, Melissa Matthijssen, Samia Lemrini, Faridi S van Etten-Jamaludin, Frank W Bloemers
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引用次数: 0

摘要

目的:系统回顾所有关于急诊科共同决策(SDM)的障碍、促进因素和现有工具的研究:目的:系统回顾所有研究,重点关注急诊科(EDs)中共同决策(SDM)的障碍、促进因素和现有工具:背景:考虑到急诊科的快节奏环境和有时危及生命的情况,在急诊科实施 SDM 似乎特别具有挑战性。背景:考虑到急诊室环境节奏快,有时会出现危及生命的情况,在急诊室实施 SDM 似乎尤为困难:方法:在 MEDLINE、Embase 和 Cochrane 图书馆中进行文献检索,截止日期为 2023 年 11 月。纳入的观察性和干预性研究涉及 SDM 的障碍或促进因素,或调查 PtDA 对就诊于急诊室的患者 SDM 水平的影响:我们筛选了 1946 项符合条件的研究,其中 33 项被纳入。在急诊室研究的PtDA涉及胸痛、晕厥、镇痛剂使用、腰椎穿刺、输尿管结石、血管通路、脑震荡/脑出血、头部CT选择、老年人指导以及阑尾炎患者的激活。仅对主要结果进行了荟萃分析,结果表明,PtDAs 显著提高了 SDM 水平(在 100 分的 OPTION 量表中为 18.8;95% CI 为 12.5-25.0)。此外,PtDAs 还倾向于增加患者知识、减少决策冲突和降低医疗服务使用率,但对患者总体满意度没有明显影响。研究发现了三个层面的障碍和促进因素:(1)患者层面--情绪、健康知识和自身的主动性;(2)临床医生层面--对医疗法律后果的恐惧、缺乏SDM技能或知识以及对治疗优越性的看法;(3)系统层面--时间限制、机构指南和PtDAs的可用性:结论:急诊室的环境通常不利于 SDM。然而,针对急诊室病症的 "PtDA "有助于克服 SDM 的障碍,并受到患者的欢迎。即使在急诊室,SDM 也是可行的,而且有越来越多的工具为患者和医生提供支持。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Systematic review of barriers, facilitators, and tools to promote shared decision making in the emergency department.

Objective: The objective was to systematically review all studies focusing on barriers, facilitators, and tools currently available for shared decision making (SDM) in emergency departments (EDs).

Background: Implementing SDM in EDs seems particularly challenging, considering the fast-paced environment and sometimes life-threatening situations. Over 10 years ago, a previous review revealed only a few patient decision aids (PtDAs) available for EDs.

Methods: Literature searches were conducted in MEDLINE, Embase, and Cochrane library, up to November 2023. Observational and interventional studies were included to address barriers or facilitators for SDM or to investigate effects of PtDAs on the level of SDM for patients visiting an ED.

Results: We screened 1946 studies for eligibility, of which 33 were included. PtDAs studied in EDs address chest pain, syncope, analgesics usage, lumbar puncture, ureterolithiasis, vascular access, concussion/brain bleeding, head-CT choice, coaching for elderly people, and activation of patients with appendicitis. Only the primary outcome was meta-analyzed, showing that PtDAs significantly increased the level of SDM (18.8 on the 100-point OPTION scale; 95% CI 12.5-25.0). PtDAs also tended to increase patient knowledge, decrease decisional conflict and decrease health care services usage, with no obvious effect on overall patient satisfaction. Barriers and facilitators were identified on three levels: (1) patient level-emotions, health literacy, and their own proactivity; (2) clinician level-fear of medicolegal consequences, lack of SDM skills or knowledge, and their ideas about treatment superiority; and (3) system level-time constraints, institutional guidelines, and availability of PtDAs.

Conclusions: Circumstances in EDs are generally less favorable for SDM. However, PtDAs for conditions seen in EDs are helpful in overcoming barriers to SDM and are welcomed by patients. Even in EDs, SDM is feasible and supported by an increasing number of tools for patients and physicians.

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来源期刊
Academic Emergency Medicine
Academic Emergency Medicine 医学-急救医学
CiteScore
7.60
自引率
6.80%
发文量
207
审稿时长
3-8 weeks
期刊介绍: Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.
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