TY -的盟Syrowatka有空盟——Kromker Dorthe盟——Meguerditchian Ari N AU - Tamblyn, Robyn PY - 2016 DA - 2016/01/26 TI -计算机辅助决策系统的功能:系统综述、专题合成、地中海和荟萃分析乔- J互联网Res SP - e20六世——18 - 1 KW -电脑KW -决策KW -决策支持系统,临床KW -互联网KW -医学信息学KW -病人参与KW -病人偏好KW -病人AB -背景:病人信息和教育，如决策辅助，正逐渐向在线、基于计算机的环境发展。已经进行了相当多的研究来指导决策辅助的内容和表示。然而，由于向基于计算机的支持的相对较新的转变，很少有人关注多媒体和交互性如何改进基于纸张的决策辅助。目的:本综述的第一个目的是将已发表的文献总结为已集成到基于计算机的决策辅助中的特征分类。在此分类的基础上，第二个目标是评估特定特征的整合是否与更高质量的决策相关。方法:检索MEDLINE、Embase、CINAHL、CENTRAL数据库，定位相关研究。该综述确定了一些研究，这些研究评估了基于计算机的决策辅助，用于面临偏好敏感的医疗决策的成年人，并报告了决策结果的质量。进行了专题综合，以发展特征分类。随后，根据来自报告知识或决策冲突的随机对照试验(rct)的标准化平均差异(SMD)进行荟萃分析。 Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Results: Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than others. Integration of content control improved quality of decision making (SMD 0.59 vs 0.23 for knowledge; SMD 0.39 vs 0.29 for decisional conflict). In contrast, tailoring reduced quality of decision making (SMD 0.40 vs 0.71 for knowledge; SMD 0.25 vs 0.52 for decisional conflict). Similarly, patient narratives also reduced quality of decision making (SMD 0.43 vs 0.65 for knowledge; SMD 0.17 vs 0.46 for decisional conflict). Results were varied for different types of explicit values clarification, feedback, and social support. Conclusions: Integration of media rich or interactive features into computer-based decision aids can improve quality of preference-sensitive decision making. However, this is an emerging field with limited evidence to guide use. The systematic review and thematic synthesis identified features that have been integrated into available computer-based decision aids, in an effort to facilitate reporting of these features and to promote integration of such features into decision aids. The meta-analyses and associated subgroup analyses provide preliminary evidence to support integration of specific features into future decision aids. Further research can focus on clarifying independent contributions of specific features through experimental designs and refining the designs of features to improve effectiveness. SN - 1438-8871 UR - //www.mybigtv.com/2016/1/e20/ UR - https://doi.org/10.2196/jmir.4982 UR - http://www.ncbi.nlm.nih.gov/pubmed/26813512 DO - 10.2196/jmir.4982 ID - info:doi/10.2196/jmir.4982 ER -