Table1_Comparison of analog and digital patient decision aids for the treatment of depression: a scoping review.docx

IntroductionPatient decision aids (PDAs) are important tools to empower patients and integrate their preferences and values in the decision-making process. Even though patients with mental health problems have a strong interest in being more involved in decision making about their treatment, research has mainly focused on PDAs for somatic conditions. In this scoping review, we focus on patients suffering from depression and the role of PDAs for this patient group. The review offers an overview of digital and analog PDAs, their advantages and disadvantages as well as recommendations for further research and development.
MethodsA systematic search of the existing literature guided by the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - extension for scoping reviews (PRISMA-ScR) was conducted. Three electronic literature databases with the appropriate thematic focus were searched (PubMed, PsycInfo, and Web of Science). The search strategy used controlled and natural language to search for the key concepts decision aids and depression. The articles were selected in a two-step process guided by predefined inclusion and exclusion criteria. We narratively synthetized information extracted from 40 research articles.
ResultsWe included 40 articles in our review. Our review revealed that there is more focus on digital PDAs in research than in clinical practice. Digitalization can enhance the benefits of PDAs by developing tools that are more efficient, interactive, and personalized. The main disadvantages of both types of PDAs for the treatment of depression are related to time, dissemination, and capacity building for the health care providers. Digital PDAs need to be regularly updated, effective strategies for their dissemination and acceptance need to be identified, and clinicians need sufficient training on how to use digital PDAs. There is more research needed to study which forms of PDAs are most appropriate for various patient groups (e.g., older adults, or patients with comorbidities), and to identify the most effective ways of PDAs' integration in the clinical workflow. The findings from our review could be well aligned with the International Patient Decision Aids Standards.
DiscussionMore research is needed regarding effective strategies for the implementation of digital PDAs into the clinical workflow, ethical issues raised by the digital format, and opportunities of tailoring PDAs for diverse patient groups.

引言
患者决策辅助工具（Patient Decision Aids，PDAs）是赋能患者、将其偏好与价值观融入诊疗决策流程的重要工具。尽管精神健康问题患者对更深度参与自身治疗决策抱有强烈意愿，但现有研究主要聚焦于躯体疾病相关的PDAs。本次范围综述聚焦于抑郁症患者群体，以及PDAs在该群体中的应用价值。本综述系统梳理了数字式与实体式PDAs的优劣势，并对后续研究与开发方向提出建议。
方法
本研究遵循《Cochrane系统评价手册》与《系统评价与元分析首选报告条目：范围综述扩展版》（PRISMA-ScR）的规范，对现有文献开展系统性检索。本次检索选取3个符合主题方向的电子文献数据库：PubMed、PsycInfo与Web of Science。检索策略结合受控词汇与自然语言，针对决策辅助工具与抑郁症两大核心概念进行检索。研究采用两步筛选流程，依据预先设定的纳入与排除标准遴选文献，并对从40篇研究论文中提取的信息开展叙述性综合分析。
结果
本综述共纳入40篇文献。结果显示，相较于临床实践，现有研究对数字式PDAs的关注度更高。数字化可通过开发更高效、更具交互性与个性化的工具，强化PDAs的应用价值。两类PDAs用于抑郁症治疗的主要局限均围绕时间成本、推广传播与医护人员能力建设三个维度。数字式PDAs需定期更新，需探索有效的推广与接纳策略，同时医护人员需接受充分的数字式PDAs使用培训。未来仍需开展更多研究，明确适配不同患者群体（如老年人群或合并症患者）的PDAs形式，并探索将PDAs高效融入临床工作流程的最优方案。本综述的研究结果与《国际患者决策辅助工具标准》高度契合。
讨论
未来仍需开展更多研究，探索将数字式PDAs融入临床工作流程的有效策略、数字形式带来的伦理问题，以及为不同患者群体定制PDAs的可行路径。