ISSN 1672-9234　CN 11-5289/R
主管：中国科学技术协会　主办：中华护理学会
出版：中华护理杂志社
收录：中国科学引文数据库（CSCD）来源期刊
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中华护理教育

中华护理教育 ›› 2023, Vol. 20 ›› Issue (4): 500-507.doi: 10.3761/j.issn.1672-9234.2023.04.021

• 综述 • 上一篇    下一篇

慢性肾病患者肾脏替代治疗辅助决策工具开发与验证研究的范围综述

郑旭彤(),张曼,秦朱珠,叶欣欣,陈小凤,王周华,詹陈菊()   

  1. 350000 福州市 福建中医药大学护理学院（郑旭彤，秦朱珠，陈小凤）；716000 延安市 延安大学医学院（张曼）；310000 杭州市 浙江大学医学院（叶欣欣）；355000 宁德市 福建医科大学附属闽东医院肾内科（王周华），护理部（詹陈菊）
  • 收稿日期:2022-05-09 出版日期:2023-04-15 发布日期:2023-04-19
  • 通讯作者: 詹陈菊，E-mail：chenjuzhan@yeah.net
  • 作者简介:郑旭彤：男，本科（硕士在读），E-mail：mmdzxt@outlook.com
  • 基金资助:
    2021年福建省卫生健康青年科研课题(2021QNA076)

Patient decision aids for patients with chronic kidney disease in choosing modality of the renal replacement therapy：a scoping review

ZHENG Xutong(),ZHANG Man,QIN Zhuzhu,YE Xinxin,CHEN Xiaofeng,WANG Zhouhua,ZHAN Chenju()   

  • Received:2022-05-09 Online:2023-04-15 Published:2023-04-19

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摘要：

目的 对慢性肾病领域关于肾脏替代治疗的辅助决策工具进行范围审查，以识别辅助决策工具的开发与验证的方法及内容要素，为我国慢性肾病辅助决策工具的开发提供指导。方法 以Arksey和O’Malley提出的范围综述五步法为方法学框架，检索PubMed、OVID数据库（Embase、Cochrane Library、JBI循证数据库）、CINAHL、ProQuest、渥太华医院研究所、英国国家卫生与临床优化研究所、Option Grids网、中国知网、万方数据库、维普数据库中的相关研究。检索时限为建库至2022年2月24日。对纳入的文献进行统计、汇总和分析。结果 共纳入26篇文献，包括14项辅助决策工具开发与验证的相关研究和12个辅助决策工具。慢性肾病辅助决策工具的开发人员可以分为利益相关者与非利益相关者，其通常选用渥太华决策支持框架、国际患者决策辅助标准作为其开发的标准或理论框架。验证性研究主要涉及工具的可行性和可用性、患者的决策相关结局、患者的知识水平变化3个方面。内容要素主要包括健康信息、决策指导、参考证据及补充信息。信息的呈现形式主要包括：使用图表呈现晦涩、抽象的知识；以评分表帮助患者整理自己的决策偏好；通过网页实现交互式功能。结论 辅助决策工具不仅可有效提升慢性肾病患者知识水平及决策质量，且有着良好的接受性和易用性。未来需要结合我国医疗现状，研发适用于我国肾病患者的辅助决策工具，并探索推广时的促进和阻碍因素，促进共享决策理念在我国的推广。

关键词: 肾功能衰竭, 慢性, 肾替代疗法, 决策支持技术, 综述, 辅助决策工具, 共享决策

Abstract:

Objective To examine the scope of patient decision tools for renal replacement therapy in the field of chronic kidney disease，to identify the methods and core elements of the development and validation of patient decision aids，and to provide guidance for the development of patient decision aids in China. Methods This scoping review was conducted under the guideline of the framework with a five-step approach developed by Arksey and O’Malley. A comprehensive search of literature was conducted in databases including PubMed，OVID database （Embase，Cochrane Library，JBI evidence-based database），CINAHL，ProQuest database，Ottawa Hospital Research Institute，NICE，and Option Grids，CNKI，Wanfang Data，and VIP Database. The limit of time was set from the date of databases’ establishment to February 24，2022. The qualified studies were analyzed and summarized. Results A total of 26 articles were included，including 14 studies related to the development and validation of patient decision aids，and 12 focused on patient decision aids tools. Generally，both stakeholders and non-stakeholders were involved in the development process of patients decision tools for chronic kidney disease. Meanwhile，Ottawa Decision support Framework and international patient decision aid standards were usually selected as the standard or theoretical framework for development. Validation research mainly involved three aspects：feasibility and availability of the tool，decision-related outcome of patients，and change of knowledge level among patients. The content elements mainly included health information，decision guidance，reference evidence，and supplementary information. The forms of information presentation mainly included：using diagrams to present obscure and abstract knowledge；employing a rating scale to help patients sort out their decision-making preferences，and realizing interactive functions through web pages. Conclusion Patient decision aids hold a positive impact on the pre-dialysis education of patients with chronic kidney disease and presents good acceptability and ease to use. Future research needs to consider the specific medical situation in China to develop more suitable patients decision aids and explore the facilitating and obstructive factors in promoting the implementation of shared decision-making.

Key words: Kidney Failure, Chronic, Renal Replacement Therapy, Decision Support Techniques, Review, Patient decision aids, Shared decision making