Decision aids clinical application among cardiovascular disease patients: a systematic review

Abstract

Objective To systematically review the development factors and clinical application of decision aids among cardiovascular disease patients so as to provide an evidence-based basis for pushing shared decision-making of doctor-patient forward. Methods From establishing the database to December 2017, we retrieved and included randomized controlled trials (RCTs) on cardiovascular disease patient decision aids in PubMed, Web of Science, CIHNAL and Cochrane Library by computer. The RCTs were screened based on inclusive criteria and were evaluated with the Cochrane risk of bias assessment tool (5.1.0) to describe the development factors of patient decision aids and to qualitatively evaluate the intervention effects of outcome indicators. Results A total of 13 literatures were included referring to clinical decision such as medication, valve replacement, percutaneous coronary intervention (PCI) stent, chest pain examination and cardiovascular disease advance. Among 13 literatures, the overall quality is in the medium level including 3 with level A and 10 with level B. Qualitative analysis showed that: (i) In present period, development of patient decision aids mainly referred to the quality evaluation criteria published by the International Patient Decision Aids Collaboration, and core content of the tool included information support, advantages and disadvantages analysis of scheme as well as the clarification of patient values; (ii) in the application researches of patient decision aids, 11 of them improved patients' knowledge, 3 of them heightened risk perception and 3 of them promoted participation in decision-making. Conclusions Cardiovascular disease patient decision aids based on evidence-based structured decision support realizes the unification of best clinical evidence and patient values which helps improving patients' knowledge, risk perception and participation in decision-making and is an effective mean to carry out shared decision-making medical model. Key words: Cardiovascular diseases; Patient decision aids; Decision making of doctor-patient; Evidence transformation; Systematic review