Decision coaching for people making healthcare decisions.

Autor:	Jull J; School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada., Köpke S; Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany., Smith M; Cochrane Consumer Network Executive, Ottawa, Canada., Carley M; Ottawa Hospital Research Institute, Ottawa, Canada., Finderup J; Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.; Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark., Rahn AC; Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lubeck, Lubeck, Germany., Boland L; Integrated Knowledge Translation Research Network, The Ottawa Hospital Research Institute, Ottawa, Canada.; Western University, London, Canada., Dunn S; BORN Ontario, CHEO Research Institute, School of Nursing, University of Ottawa, Ottawa, Canada., Dwyer AA; William F. Connell School of Nursing, Boston University, Chestnut Hill, Massachusetts, USA.; Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA., Kasper J; Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway., Kienlin SM; Faculty of Health Sciences, Department of Health and Caring Sciences, University of Tromsø, Tromsø, Norway.; The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Hamar, Norway., Légaré F; Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Canada., Lewis KB; School of Nursing, University of Ottawa, Ottawa, Canada.; University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada., Lyddiatt A; No affiliation, Ingersoll, Canada., Rutherford C; School of Psychology, Quality of Life Office, University of Sydney, Camperdown, Australia.; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia., Zhao J; School of Nursing, University of Ottawa, Ottawa, Canada., Rader T; Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada., Graham ID; Ottawa Hospital Research Institute, Ottawa, Canada.; School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada., Stacey D; School of Nursing, University of Ottawa, Ottawa, Canada.
Jazyk:	angličtina
Zdroj:	The Cochrane database of systematic reviews [Cochrane Database Syst Rev] 2021 Nov 08; Vol. 11. Cochrane AN: CD013385. Date of Electronic Publication: 2021 Nov 08.
DOI:	10.1002/14651858.CD013385.pub2
Abstrakt:	Background: Decision coaching is non-directive support delivered by a healthcare provider to help patients prepare to actively participate in making a health decision. 'Healthcare providers' are considered to be all people who are engaged in actions whose primary intent is to protect and improve health (e.g. nurses, doctors, pharmacists, social workers, health support workers such as peer health workers). Little is known about the effectiveness of decision coaching. Objectives: To determine the effects of decision coaching (I) for people facing healthcare decisions for themselves or a family member (P) compared to (C) usual care or evidence-based intervention only, on outcomes (O) related to preparation for decision making, decisional needs and potential adverse effects. Search Methods: We searched the Cochrane Library (Wiley), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL (Ebsco), Nursing and Allied Health Source (ProQuest), and Web of Science from database inception to June 2021. Selection Criteria: We included randomised controlled trials (RCTs) where the intervention was provided to adults or children preparing to make a treatment or screening healthcare decision for themselves or a family member. Decision coaching was defined as: a) delivered individually by a healthcare provider who is trained or using a protocol; and b) providing non-directive support and preparing an adult or child to participate in a healthcare decision. Comparisons included usual care or an alternate intervention. There were no language restrictions. Data Collection and Analysis: Two authors independently screened citations, assessed risk of bias, and extracted data on characteristics of the intervention(s) and outcomes. Any disagreements were resolved by discussion to reach consensus. We used the standardised mean difference (SMD) with 95% confidence intervals (CI) as the measures of treatment effect and, where possible, synthesised results using a random-effects model. If more than one study measured the same outcome using different tools, we used a random-effects model to calculate the standardised mean difference (SMD) and 95% CI. We presented outcomes in summary of findings tables and applied GRADE methods to rate the certainty of the evidence. Main Results: Out of 12,984 citations screened, we included 28 studies of decision coaching interventions alone or in combination with evidence-based information, involving 5509 adult participants (aged 18 to 85 years; 64% female, 52% white, 33% African-American/Black; 68% post-secondary education). The studies evaluated decision coaching used for a range of healthcare decisions (e.g. treatment decisions for cancer, menopause, mental illness, advancing kidney disease; screening decisions for cancer, genetic testing). Four of the 28 studies included three comparator arms.  For decision coaching compared with usual care (n = 4 studies), we are uncertain if decision coaching compared with usual care improves any outcomes (i.e. preparation for decision making, decision self-confidence, knowledge, decision regret, anxiety) as the certainty of the evidence was very low.  For decision coaching compared with evidence-based information only (n = 4 studies), there is low certainty-evidence that participants exposed to decision coaching may have little or no change in knowledge (SMD -0.23, 95% CI: -0.50 to 0.04; 3 studies, 406 participants). There is low certainty-evidence that participants exposed to decision coaching may have little or no change in anxiety, compared with evidence-based information. We are uncertain if decision coaching compared with evidence-based information improves other outcomes (i.e. decision self-confidence, feeling uninformed) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with usual care (n = 17 studies), there is low certainty-evidence that participants may have improved knowledge (SMD 9.3, 95% CI: 6.6 to 12.1; 5 studies, 1073 participants). We are uncertain if decision coaching plus evidence-based information compared with usual care improves other outcomes (i.e. preparation for decision making, decision self-confidence, feeling uninformed, unclear values, feeling unsupported, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with evidence-based information only (n = 7 studies), we are uncertain if decision coaching plus evidence-based information compared with evidence-based information only improves any outcomes (i.e. feeling uninformed, unclear values, feeling unsupported, knowledge, anxiety) as the certainty of the evidence was very low. Authors' Conclusions: Decision coaching may improve participants' knowledge when used with evidence-based information. Our findings do not indicate any significant adverse effects (e.g. decision regret, anxiety) with the use of decision coaching. It is not possible to establish strong conclusions for other outcomes. It is unclear if decision coaching always needs to be paired with evidence-informed information. Further research is needed to establish the effectiveness of decision coaching for a broader range of outcomes. (Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)
Databáze:	MEDLINE
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