Abstract:

Objective To conduct a scoping review of the application of decision aid （DA） in the nursing decision making of patients with dementia，identify the elements and application status of DA intervention，and provide references for the practice of DA and related research. Methods Pubmed，CINAHL，Cochrane Library，Embase，PsycINFO，CNKI，Wanfang database，CBM and VIP database were searched. The time limit for the search was from the establishment of databases until July 31，2023. The included literature was summarized and analyzed. Results A total of 19 articles were included，and topics on DA included advance care planning，care models，feeding choices，daily living，and goal of care decisions. The content elements of DA include providing information related to the patient’s physical condition and decision-making topics，providing alternative decision options and describing advantages and disadvantages，clarifying values and treatment preferences，and interactive decision support communication with peers and professionals. The outcome measures include decision process indicators，decision quality indicators and feasibility evaluation. Conclusion DA can significantly reduce the level of decision conflict between patients and caregivers，improve the quality of decision-making，with good feasibility. More high-quality randomized controlled studies with homogeneous interventions are needed in the future，in order to improve the effect evaluation index，and explore the best intervention time of DA，strengthen the professional support in the decision-making process，and accelerate the development of local relevant DA according to the specific practice situation in China，so as to provide high-quality decision support for dementia patients and caregivers.

Key words: Decision Aids, Dementia, Family Caregivers, Proxy Decision-Making, Scoping Review, Nursing Care

摘要：

目的 对决策辅助工具（decision aids，DA）在失智症患者照护中的应用研究进行范围审查，识别DA干预的要素及应用现状，为未来开展该领域的实践和相关研究提供借鉴。方法 检索PubMed、CINAHL、Web of Sciences、Embase、PsycINFO、中国知网、万方数据库、中国生物医学文献数据库、维普数据库。检索时限为建库至2023年7月31日。对纳入文献进行汇总和分析。结果 共纳入19篇文献，DA涵盖的主题包括预先护理计划、照护模式决策、喂养选择、日常生活及姑息治疗决策。DA的内容要素包括提供与患者身体状况及决策主题相关的信息指导、与决策方案有关的风险利弊说明、澄清价值观及护理偏好、交互式决策沟通支持。结局指标包括决策过程指标、决策质量指标和可行性指标。结论 DA可显著降低患者及其照护者的决策冲突水平，提高决策质量，并具有良好的可行性。未来需在同质化干预条件下开展更多高质量的随机对照研究，完善评价指标，并探索DA最佳干预时机，加强决策过程中的专业支持，结合我国具体实践情境，加快相关DA的开发，为失智症患者及其照护者提供高质量的决策支持。

关键词: 决策辅助工具, 失智症, 家庭照护者, 代理决策, 范围综述, 护理