Systematic evaluation of decision aids in patients with first stroke
ZHANG Min1 DING Xiaotong2 LI Xianwen3▲
1.Department of Neurology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Jiangsu Province, Nanjing 210008, China;
2.School of Nursing, Peking Union Medical College, Beijing 100144, China;
3.School of Nursing, Nanjing Medical University, Jiangsu Province, Nanjing 211116, China
Abstract：Objective To systematically evaluate the effect of decision aids in patients with first stroke. Methods Literatures on the application of decision aids in first stroke patients from the inception to June, 2021 of the Cochrane Library, PubMed, Embase, CINAHL, CBM, CNKI, and Wanfang Data were searched. The literatures were screened and evaluated for quality. RevMan 5.3 software was used for meta-analysis. Results A total of five articles were included. There were no significant differences in mortality (RR = 0.61, 95%CI: 0.20-1.88, P = 0.39) and incidence of cerebral hemorrhage after thrombolysis (RR = 0.86, 95%CI: 0.31-2.41, P = 0.77) between the two groups. The 60 min thrombolytic rate (RR = 1.44, 95%CI: 1.16-1.78, P = 0.001) and thrombolytic decision agreement rate (RR = 1.12, 95%CI: 1.01-1.25, P = 0.03) in the experimental group were higher than those in the control group, and the differences were statistically significant. Conclusion Decision aids in patients with first stroke can improve the 60 min thrombolytic rate and thrombolytic decision agreement rate, and it is safe, which is worthy of further clinical research and promotion.
张敏1 丁晓彤2 李现文3▲. 决策辅助在首次脑卒中患者中应用效果的系统评价[J]. 中国医药导报, 2022, 19(17): 84-87.
ZHANG Min1 DING Xiaotong2 LI Xianwen3▲. Systematic evaluation of decision aids in patients with first stroke. 中国医药导报, 2022, 19(17): 84-87.
[1] 王亚楠，吴思缈，刘鸣.中国脑卒中15年变化趋势和特点[J].华西医学，2021，36（6）：803-807.
[2] Wu SM，Wu B，Liu M，et al. Stroke in China：advances and challenges in epidemiology，prevention，and management [J]. Lancet Neurol，2019，18（4）：394-405.
[3] 《中国脑卒中防治报告》编写组.《中国脑卒中防治报告2019》概要[J].中国脑血管病杂志，2020，17（5）：272-281.
[4] Charles C，Gafni A，Whelan T. Shared decision-making in the medical encounter：what does it mean？（or it takes at least two to tango）[J]. Soc Sci & Med，1997，44（5）：681-692.
[5] Korteland NM，Ahmed Y，Koolbergen DR，et al. Does the Use of a Decision Aid Improve Decision Making in Prosthetic Heart Valve Selection？A Multicenter Randomized Trial [J]. Circ Cardiovasc Qual Outcomes，2017，10（2）：e3178.
[6] Madden K，Kleinlugtenbelt YV. Cochrane in CORR?誖：Decision Aids for People Facing Health Treatment or Screening Decisions [J]. Clin Orthop & Relat Res，2017， 475（5）：1-7.
[7] Karlsson LO，Staffan N，Magnus BN，et al. A clinical decision support tool for improving adherence to guidelines on anticoagulant therapy in patients with atrial fibrillation at risk of stroke：A cluster-randomized trial in a Swedish primary care setting（the CDS-AF study）[J]. PLoS Med，2018，15（3）：e1002528.
[8] Gregory P，Shelley H，Claire EG，et al. Alert-based computerized decision support for high-risk hospitalized patients with atrial fibrillation not prescribed anticoagulation：a randomized，controlled trial（AF-ALERT）[J]. Eur Heart J，2019，41（10）：1086-1096.
[9] Smith TJ，Dow LA，Virago EA，et al. A Pilot Trial of Decision Aids to Give Truthful Prognostic and Treatment Information to Chemotherapy Patients with Advanced Cancer [J]. J Support Oncol，2011，9（2）：79-86.
[10] Shuster JJ. Review：Cochrane handbook for systematic reviews for interventions，Version 5.1.0，published 3/2011. Julian P.T. Higgins and Sally Green，Editors [J]. Res Synth Methods，2011，2（2）：126-130.
[11] 周英凤，顾莺，胡雁，等.JBI循证卫生保健中心关于不同类型研究的质量评价工具——干预性研究的质量评价[J].护士进修杂志，2018，33（2）：112-113.
[12] Ranta A，Dovey S，Weatherall M，et al. Cluster randomized controlled trial of TIA electronic decision support in primary care [J]. Neurology，2015，84（15）：1545-1551.
[13] Majersik JJ，Meurer WJ，Frederiksen SA，et al. Observational study of telephone consults by stroke experts supporting community tissue plasminogen activator delivery [J]. Acad Emerg Med，2012，19（9）：E1027-E1034.
[14] Meyer BC，Raman R，Hemmen T，et al. Efficacy of site-independent telemedicine in the STRokE DOC trial：a randomised，blinded，prospective study [J]. Lancet Neurol，2008，7（9）：787-795.
[15] 杨冬梅，程俊亚，曹伟，等.基于正面框架理论的谈话手册对脑卒中患者溶栓决策的影响研究[J].护理与康复，2019，18（1）：45-47.
[16] 王萍.临床依据正面信息前置呈现式谈话手册在脑卒中患者溶栓决策引导中的应用[J].护理实践与研究，2020，17（11）：82-83.
[17] Laryionava K，Schildmann J，Wensing M，et al. Development and Evaluation of a Decision Aid to Support Patients’Participatory Decision-Making for Tumor-Specific and Palliative Therapy for Advanced Cancer：Protocol for a Pre-Post Study [J]. JMIR Res Protoc，2021，10（9）：e24954.
[18] Nagayama H，Tomori K，Ohno K，et al. Cost effectiveness of the occupation-based approach for subacute stroke patients：result of a randomized controlled trial [J]. Top Stroke Rehabil，2017，24（5）：337-344.
[19] Raphael DB，Russell NS，Winkens B，et al. A patient decision aid for breast cancer patients deciding on their radiation treatment，no change in decisional conflict but better informed choices [J]. Tech Innov Patient Support Radiat Oncol，2021，20：1-9.
[20] 杨威，朱雪梅，沈晓颖，等.首发急性缺血性脑卒中患者就医决策延迟与希望水平、社会支持和应对方式的相关性[J].解放军护理杂志，2021，38（6）：42-45.
[21] 周献中.指挥自动化系统辅助决策技术[M].北京：国防工业出版社，2012：9-10.
[22] Goostrey KJ，Lee C，Jones K，et al. Adapting a Traumatic Brain Injury Goals-of-Care Decision Aid for Critically Ill Patients to Intracerebral Hemorrhage and Hemispheric Acute Ischemic Stroke[J]. Crit Care Explor，2021，3（3）：e0357.
[23] 潘习，徐岚，李小勤，等.护士参与的决策辅助方案在急性脑梗死静脉溶栓获取知情同意中的应用[J].中国护理管理，2019，19（12）：1904-1909.
[24] Weir C J，Lees KR，Macwalter RS，et al. Cluster-randomized，controlled trial of computer-based decision support for selecting long-term anti-thrombotic therapy after acute ischaemic stroke[J]. QJM， 2003，96（2）：143-153.
京公网安备 11010502046598号