Shared decision-making when choosing the feeding method of patients with severe dementia: a systematic review

Abstract Objectives: To evaluate whether the use of a support tool for shared decision-making in the choice of feeding method for patients with severe dementia can benefit the patient/caregiver dyad, and to evaluate the quality of the decision-making process. Method: A search was performed in the Medline, LILACS, IBECS, SciELO, WHOLIS databases for randomized controlled trials, whether double-blind or otherwise, and quasi-experimental, cohort, case-control, or cross-sectional observational studies in Portuguese, Spanish, English and French. Results: Eight articles were found that showed that the use of a decision support tool, as an aid for the shared decision-making method, is beneficial as it reduces decisional conflict and increases the knowledge of caregivers about the subject. The quality of the decision-making process is unsatisfactory due to the low frequency of discussions between caregivers and the health team and the poor evaluation of caregivers about the participation of the team in the decision-making process. Conclusion: Decision support tools provide benefits for caregivers/patients undergoing the difficult task of deciding about feeding methods. Findings suggest that the current quality of decision-making is inadequate.

摘要：
研究目的：评估针对重度痴呆患者喂养方式选择的共享决策（shared decision-making）支持工具能否使患者-照护者二人组获益，并评估决策制定过程的质量。
研究方法：在Medline、LILACS、IBECS、SciELO、WHOLIS数据库中，检索葡萄牙语、西班牙语、英语、法语语种的随机对照试验（无论是否采用双盲设计），以及类实验、队列、病例对照、横断面观察性研究。
研究结果：共检索到8篇符合条件的文献，结果显示，作为共享决策辅助工具的决策支持工具（decision support tool）可降低决策冲突，并提升照护者对相关主题的认知水平，具备明确获益价值。但由于照护者与医疗团队间的讨论频次偏低，且照护者对医疗团队参与决策过程的评价欠佳，当前决策制定过程的质量仍未达理想标准。
研究结论：决策支持工具可为面临喂养方式抉择这一艰巨任务的患者及其照护者带来切实获益。本研究结果表明，当前决策制定的质量仍存在不足。