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·系统评价·

冠心病诊疗中患者决策辅助工具干预效果的系统评价

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高川 ，高莹 ，周俞余 ，郭旭芳 ，何仲 1* 扫描二维码
查看原文
【摘要】 背景 患者决策辅助工具（DA）被认为是实现医患共同决策的重要工具，然而在冠心病的诊断和治
疗中其干预效果并不明朗。目的 评价 DA 在冠心病诊疗中的应用效果。方法 计算机检索 PubMed、Web of Science、
EMBase、The Cochrane Library 数据库，采用主题词和自由词构造检索式，检索自建库至 2021 年 3 月发表的使用 DA
对冠心病患者进行干预的研究文献。依据 Cochrane 偏倚风险评估工具（RoB2 版）进行文献质量评价，提取数据，总
结 DA 的干预效果。结果 共纳入文献 6 篇，文献质量总体中等。4 篇文献为近 5 年研究；5 项研究主要来自美国；3
项研究为冠心病的治疗方式，3 项研究为疑似冠心病的胸痛诊断筛查。结果显示：（1）在 6 项研究中，2 项改变了患
者的决策行为，6 项提高了患者知识水平，3 项降低了患者的决策冲突，2 项提高了患者的决策参与程度；（2）DA 多
以网页版的形式为主，内容包括冠心病相关的信息支持、澄清方案利弊、患者价值判断。结论 在冠心病诊疗中，DA
的干预效果具有一定局限性，但其在临床仍具有广阔的应用前景。未来应该加强对临床医生的培训，设计出符合患者
特征和中国文化背景的决策辅助工具，以促进其临床应用。
【关键词】 冠心病；心血管疾病；医患共同决策；共同决策；决策支持技术；患者决策辅助工具；系统综述
【中图分类号】 R 541.4 【文献标识码】 A DOI：10.12114/j.issn.1007-9572.2021.01.042
高川，高莹，周俞余，等 . 冠心病诊疗中患者决策辅助工具干预效果的系统评价［J］. 中国全科医学，2022，25（5）：
530-534，541. ［www.chinagp.net］
GAO C，GAO Y，ZHOU Y Y，et al. Effect of patient decision aids in the diagnosis and treatment of coronary artery
disease：a systematic review［J］. Chinese General Practice，2022，25（5）：530-534，541.

Effect of Patient Decision Aids in the Diagnosis and Treatment of Coronary Artery Disease：a Systematic Review GAO
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Chuan ，GAO Ying ，ZHOU Yuyu ，GUO Xufang ，HE Zhong 1*
1.School of Humanities and Social Sciences，CAMS & PUMC，Beijing 100005，China
2.Department of Cardiology，School of Humanities and Social Sciences，CAMS & PUMC/National Center for Cardiovascular
Diseases/Fuwai Hospital，Beijing 100037，China
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Corresponding author：HE Zhong，Professor；E-mail：hezhong08@126.com
【Abstract】 Background Patient decision aid is recognized as an essential tool for shared-decision making.
However，it is not clear that its role in shared-decision making in the diagnosis and treatment of coronary artery disease（CAD）.
Objective To assess the effect of patient decision aids in the diagnosis and treatment of CAD using a systematic review. Methods
Databases of PubMed，Web of Science，EMBase and The Cochrane Library were searched from inception to March 2021 for
randomized trials assessing the effect of patient decision aids used in the diagnosis and treatment of CAD patients using a type of
searching algorithm consisting of subject headings and free words. The Cochrane risk-of-bias tool for randomized trials（RoB2）
was used for assessing risk of bias. Data were extracted，and effects of patient decision aids were summarized. Results A total
of six randomized trials were included，and their qualities were moderate on the whole. Four were published within the past five
years；five were conducted in the United States；three focus on the treatment of CAD and another three are about chest pain
assessment due to suspected CAD. The effects of patient decision aids were summarized as follows：（1） With the support of
a patient decision aid，patients obtained changes in their decision-making behaviors（two studies），increased CAD-related
knowledge（all studies），reduced decisional conflicts（three studies），and higher rate of attending decision-making（two
studies）. （2） Most of the patient decision aids are web-based，and their contents mainly include information related to CAD，
clarifying the pros and cons of treatment schemes for CAD，and personal risk assessments. Conclusion The effects of patient
decision aids are limited in the diagnosis and treatment of CAD，yet they have broad prospect in clinical practice. To promote their

1.100005 北京市，中国医学科学院北京协和医学院人文和社会科学学院
2.100037 北京市，中国医学科学院北京协和医学院 国家心血管病中心 阜外医院心内科
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通信作者：何仲，教授；E-mail：hezhong08@126.com
本文数字出版日期：2022-01-04