Patient Preferences and Shared Decision Making in the Treatment of Substance Use Disorders: A Systematic Review of the Literature

Background
Shared Decision Making (SDM) as means to the involvement of patients in medical decision making is increasingly demanded by treatment guidelines and legislation. Also, matching of patients’ preferences to treatments has been shown to be effective regarding symptom reduction. Despite promising results for patients with substance use disorders (SUD) no systematic evaluation of the literature has been provided. The aim is therefore to give a systematic overview of the literature of patient preferences and SDM in the treatment of patients with SUD.
Methods
An electronic literature search of the databases Medline, Embase, Psyndex and Clinical Trials Register was performed. Variations of the search terms substance use disorders, patient preferences and SDM were used. For data synthesis the populations, interventions and outcomes were summarized and described according to the PRISMA statement. Methodological quality of the included articles was assessed with the Mixed Methods Appraisal Tool.
Results
N = 25 trials were included in this review. These were conducted between 1986 and 2014 with altogether n = 8.729 patients. Two studies found that patients with SUD preferred to be actively involved in treatment decisions. Treatment preferences were assessed in n = 18 studies, where the majority of patients preferred outpatient compared with inpatient treatment. Matching patients to preferences resulted in a reduction on substance use (n = 3 studies), but the majority of studies found no significant effect. Interventions for SDM differed across patient populations and optional therapeutic techniques.
Discussion
Patients with substance use disorders should be involved in medical treatment decisions, as patients with other health conditions. A suitable approach is Shared Decision Making, emphasizing the patients’ preferences. However, due to the heterogeneity of the included studies, results should be interpreted with caution. Further research is needed regarding SDM interventions in patient populations with substance use disorders.

背景
共同决策（Shared Decision Making, SDM）作为让患者参与医疗决策的手段，日益受到治疗指南与立法的要求。此外，将患者偏好与治疗方案相匹配在缓解症状方面已被证实有效。尽管针对物质使用障碍（substance use disorders, SUD）患者的相关研究已取得可喜成果，但目前尚无针对该领域文献的系统性综述。因此本研究旨在对物质使用障碍患者治疗中涉及患者偏好与共同决策的相关文献进行系统性概述。

方法
本研究对Medline、Embase、Psyndex及临床试验注册库（Clinical Trials Register）开展电子文献检索，检索词涵盖物质使用障碍、患者偏好及共同决策的多种变体形式。依据PRISMA声明，对纳入研究的人群、干预措施及结局指标进行汇总与描述。采用混合方法评价工具（Mixed Methods Appraisal Tool）对纳入文献的方法学质量进行评估。

结果
本综述共纳入25项试验，研究时间跨度为1986年至2014年，总计纳入8729名患者。其中2项研究显示，物质使用障碍患者更倾向于主动参与治疗决策。18项研究对治疗偏好进行了评估，结果显示大多数患者偏好门诊治疗而非住院治疗。将治疗方案与患者偏好相匹配可减少物质使用行为（共3项研究），但多数研究未发现显著效果。共同决策的干预措施因患者人群及可选治疗技术的差异而有所不同。

讨论
与其他疾病患者一样，物质使用障碍患者也应被纳入医疗治疗决策流程。共同决策是一种合适的途径，其核心在于重视患者的偏好。但由于纳入研究存在异质性，解读研究结果时需谨慎。未来仍需针对物质使用障碍患者人群的共同决策干预措施开展进一步研究。