A systematic review to determine the presence and effectiveness of shared decision making interventions for airway clearance techniques in adults with bronchiectasis

Abstract

Background Bronchiectasis is a chronic lung disorder, impaired muco-ciliary clearance and sputum retention are core elements in bronchiectasis pathophysiology. Airway clearance is regarded as the cornerstone of therapy in bronchiectasis. There is currently a lack of randomised controlled trials (RCTs) proving the efficacy of one specific airway clearance technique (ACT) over another. Shared decision-making (SDM) interventions are usually designed for situations where there is some uncertainty about the best treatment option and provide information about the advantages and disadvantages in as balanced a way as possible. Aims To determine if and how SDM is used when choosing ACTs for adults with bronchiectasis. To determine the effectiveness of SDM when choosing ACTs for adults with bronchiectasis. Effectiveness will be measured using clinical and patient outcomes including: exacerbation frequency, hospitalisation, adverse events and mortality, patient adherence, health related quality of life, patient preference and acceptance. Objectives To systematically search and identify all studies that include the use of SDM in ACTs in adults with bronchiectasis. To critically appraise and synthesise studies to provide a summary of the effectiveness on the use of SDM in ACTs in adults with bronchiectasis. Search criteria The following electronic databases were searched: CINAHL, EMBASE, Medline, PsycINFO, Google Scholar, Web of Science and the Cochrane Library. No limit was set for publication date. The review was limited to English language publications only. Results No studies were identified for inclusion in the review. Limitations With no studies meeting criteria for inclusion, it may appear to offer no conclusions or offer conclusions not based on evidence and may seem disappointing among some clinicians and policymakers. We argue that this empty review remains important and highlights a major research gap and has identified the state of the evidence at this point in time in SDM for ACTs in bronchiectasis. Conclusions Bronchiectasis is an increasingly prevalent disease. ACTs are the cornerstone of bronchiectasis management. We have presented clear justification for further research for development of a SDM intervention for ACTs in adults with bronchiectasis.