共同决策对接受乳房重建手术的乳腺癌患者的影响：系统回顾与荟萃分析

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing Pub Date : 2024-11-01 DOI:10.1016/j.apjon.2024.100596

Lixia Chen , Jia Lu , Bo Chen , Xiaoxia Zhang

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The meta-analysis results revealed that SDM could reduce decisional conflict [mean difference (MD), −4.49; 95% confidence interval (CI) (−6.70, −2.27); <em>P</em> < 0.001], decisional regret [MD, −6.06; 95% CI (−9.51, −2.61); <em>P</em> < 0.001], and depression [standardized mean difference (SMD), −0.67; 95% CI (−0.99, −0.35); <em>P</em> < 0.001] in patients who underwent breast reconstruction surgery. In addition, SDM can improve decisional participation [SMD, 0.30; 95% CI (0.11, 0.49); <em>P</em> = 0.002] and decisional knowledge [SMD, 0.43; 95% CI (0.11, 0.75); <em>P</em> = 0.009], but with no significant improvement in decisional satisfaction [SMD, 0.30; 95% CI (−0.35, 0.94); <em>P</em> = 0.37] and anxiety [SMD, −0.09; 95% CI (−0.22, 0.04); <em>P</em> = 0.17]. 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引用次数: 0

摘要

目标必须接受乳房切除术的乳腺癌患者可接受不同类型的乳房重建手术。共同决策（SDM）是患者决策过程中的一项重要新兴干预措施。本研究旨在评估SDM在接受乳房重建手术的乳腺癌患者中的应用效果。方法在中国国家知识基础设施、万方数据库、中国生物医学数据库、VIP数据库、PubMed数据库、Cochrane图书馆、Web of Science数据库、护理与专职医疗文献累积索引数据库、Embase数据库等数据库中检索有关SDM在乳房重建患者中应用的文献。文献检索时间限制为从开始到 2024 年 2 月 29 日，语言限制为中文和英文。本研究采用《系统综述和元分析首选报告项目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses）清单进行报告。随机对照试验（RCT）质量采用 Cochrane 协作组织的偏倚风险评估工具进行评估，准随机试验采用 Joanna Briggs 研究所的关键评估工具进行评估。评估了 SDM 对决策冲突、遗憾、知识、参与、满意度、焦虑和抑郁的影响。结果在数据库检索到的 854 条记录中，共有 18 篇论文符合资格标准，包括 16 篇英文文章和 2 篇中文文章。其中有 12 项随机研究和 6 项准随机研究。荟萃分析结果显示，SDM可减少决策冲突[平均差（MD），-4.49；95%置信区间（CI）（-6.70，-2.27）；P < 0.001]、决策后悔[MD，-6.06；95% CI（-9.51，-2.61）；P <；0.001]，以及接受乳房重建手术患者的抑郁[标准化平均差（SMD），-0.67；95% CI（-0.99，-0.35）；P <；0.001]。此外，SDM 可以改善决策参与[SMD，0.30；95% CI (0.11，0.49)；P = 0.002]和决策知识[SMD，0.43；95% CI (0.11，0.75)；P = 0.009]，但在决策满意度[SMD，0.30；95% CI (-0.35，0.94)；P = 0.37]和焦虑[SMD，-0.09；95% CI (-0.22，0.04)；P = 0.17]方面没有明显改善。国家/地区亚组分析显示，SDM在西方国家的干预效果[MD，-3.84；95% CI（-4.16，-3.52）；P <；0.001]强于东方国家[MD，-1.81；95% CI（-2.32，-1.30）；P <；0.001]，Booklet组的干预效果[MD，-6.92；95% CI（-8.90，-4.结论SDM在乳房重建患者的许多方面都显示出积极作用，包括减少决策冲突、决策遗憾和抑郁，同时提高决策参与度和决策知识。此外，SDM 在西方国家似乎比在东方国家更有效，而使用小册子比使用基于计算机的方式更有效。然而，我们的研究表明，SDM 在决策满意度和焦虑方面没有益处。

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Effect of shared decision-making in patients with breast cancer undergoing breast reconstruction surgery: A systematic review and meta-analysis

Objective

Patients with breast cancer who must undergo breast mastectomy are offered different types of breast reconstruction surgeries. Shared decision-making (SDM) is an important emerging intervention in the decision-making process of patients. This study aimed to evaluate the effects of SDM in patients with breast cancer undergoing breast reconstruction surgery.

Methods

Databases, including China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, VIP, PubMed, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and Embase, were searched for articles on the application of SDM in patients undergoing breast reconstruction. The literature search retrieval time limit was from inception to February 29, 2024, with Chinese and English language restrictions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for reporting this work. The randomized controlled trial (RCT) quality was assessed using The Cochrane Collaboration's tool for assessing risk of bias and quasi-randomized trials using Joanna Briggs Institute's critical appraisal tools. The SDM effects on decisional conflict, regret, knowledge, participation, and satisfaction, anxiety, and depression were assessed. Revman5.4 software was used for the meta-analysis.

Results

In total, 18 papers out of 854 records identified from the database search met the eligibility criteria, including 16 articles in English and two articles in Chinese. There were 12 RCTs and six quasi-randomized trials. The meta-analysis results revealed that SDM could reduce decisional conflict [mean difference (MD), −4.49; 95% confidence interval (CI) (−6.70, −2.27); P < 0.001], decisional regret [MD, −6.06; 95% CI (−9.51, −2.61); P < 0.001], and depression [standardized mean difference (SMD), −0.67; 95% CI (−0.99, −0.35); P < 0.001] in patients who underwent breast reconstruction surgery. In addition, SDM can improve decisional participation [SMD, 0.30; 95% CI (0.11, 0.49); P = 0.002] and decisional knowledge [SMD, 0.43; 95% CI (0.11, 0.75); P = 0.009], but with no significant improvement in decisional satisfaction [SMD, 0.30; 95% CI (−0.35, 0.94); P = 0.37] and anxiety [SMD, −0.09; 95% CI (−0.22, 0.04); P = 0.17]. The subgroup analysis of country/region showed that the interventional effect of SDM in Western countries [MD, −3.84; 95% CI (−4.16, −3.52); P < 0.001] was stronger than that in Eastern countries [MD, −1.81; 95% CI (−2.32, −1.30); P < 0.001], and the interventional effect of Booklet group [MD, −6.92; 95% CI (−8.90, −4.94); P < 0.001] was stronger than that of Computer-based group [MD, −3.23; 95% CI (−3.50, −2.96); P < 0.001].

Conclusions

SDM shows positive effects in many aspects in patients with breast reconstruction, including reducing decisional conflict, decisional regret, and depression, whilst improving decisional participation and decisional knowledge. Moreover, SDM seems has better effectiveness in Western countries than that in Eastern countries and the implement of Booklet has better effectiveness than that of Computer-based modality. However, our study shows that SDM has no benefit in terms of decisional satisfaction and anxiety.