护士主导共享决策对高危人群低剂量CT筛查参与及结局的系统综述与荟萃分析
单臂研究中汇总低剂量CT参与率达98%，比较性研究中与常规护理无显著差异（RR 1.00, 95%CI 0.99-1.02），提示非劣效而非优效。完成筛查者中81%为良性或低风险发现，2%诊断为早期肺癌。
要点
- 护士主导共享决策在比较性研究中与常规护理相比低剂量CT参与率无显著差异，提示非劣效。
- 单臂研究汇总低剂量CT参与率98%，参与意愿68%，异质性极高（I²分别为99%和98%）。
- 完成筛查者中81%为Lung-RADS I/II良性或低风险发现，2%诊断为早期肺癌。
核心结论
- 比较性证据提示护士主导共享决策在低剂量CT参与率上达到与常规护理等效的效果，而非优效。
研究设计与样本
- 系统综述与荟萃分析，检索PubMed、Medline、Cochrane Central、EMBASE、Web of Science、Scopus、灰色文献数据库及临床试验注册库，从建库至2025年3月。
- 采用随机效应模型进行荟萃分析，使用meta回归探索异质性来源，两名评价者独立提取数据并使用ROBINS-I和Cochrane RoB 2.0评估偏倚风险。
主要发现
- 在无对照组的单臂研究中，护士主导共享决策项目的汇总低剂量CT参与率为98%（95%CI 28%至100%；I²=99%）。
- 单臂研究中参与意愿为68%（95%CI 24%至93%；I²=98%）。
- 在比较性研究中，护士主导共享决策与常规护理相比低剂量CT参与率无显著差异（RR 1.00, 95%CI 0.99至1.02；I²=0%），提示非劣效而非优效。
- 在完成筛查的个体中，81%（95%CI 77%至85%）为良性或低风险发现（Lung-RADS I/II），2%（95%CI 1%至3%）诊断为早期肺癌，与基准筛查试验率一致。
- Meta回归显示女性与参与率正相关（β=0.54, p<0.001），当前吸烟负相关（β=-0.37, p=0.033）。
关键数值与推荐
- 纳入标准为评估护士主导共享决策干预在高风险肺癌人群中报告低剂量CT参与率、筛查结果（Lung-RADS分类）、早期癌症检测或参与意愿的研究。
- 偏倚风险在研究中为中等至严重。
临床怎么用
- 护士主导共享决策可作为促进高危人群低剂量CT筛查参与的有效策略，效果与常规护理相当。
- 女性参与率较高，当前吸烟者参与率较低，临床实施中可针对性关注吸烟人群的决策支持。
- 筛查发现的良性或低风险比例及早期癌症检出率与基准试验一致，支持该决策模式的筛查安全性。
局限性
- 纳入研究偏倚风险为中等至严重。
- 单臂研究汇总参与率和意愿异质性极高（I²分别为99%和98%）。
- 比较性证据有限，仅3项比较性研究，且总体研究数量较少。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BMJ Open. 2026 Apr 22;16(4):e113486. doi: 10.1136/bmjopen-2025-113486. ABSTRACT OBJECTIVES: To evaluate the effects of nurse-led shared decision-making (SDM) on lung cancer screening outcomes, including low-dose CT (LDCT) uptake, benign findings, early cancer detection and willingness to participate among high-risk populations. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Medline via OvidSP, Cochrane Central Register of Controlled Trials, EMBASE via OvidSP, Web of Science, Scopus, grey literature databases and clinical trial registries were searched from inception to March 2025. ELIGIBILITY CRITERIA: Studies evaluating nurse-led SDM interventions in high-risk lung cancer populations, reporting outcomes including LDCT uptake rates, screening results (Lung-RADS (Lung Imaging Reporting and Data System) classifications), early-stage cancer detection or willingness to participate. Randomised controlled trials, quasi-experimental studies and observational studies were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed risk of bias using the Risk of Bias in Non-randomised Studies of Interventions (for non-randomised studies) and Cochrane Risk of Bias 2.0 (for randomised controlled trials). Meta-analyses were conducted using random-effects models. Meta-regression explored sources of heterogeneity. RESULTS: 13 studies (n=13 608 participants) were included, comprising 10 single-arm studies and three comparative studies. In single-arm studies without control groups, nurse-led SDM programmes achieved a pooled LDCT uptake rate of 98% (95% CI 28% to 100%; I²=99%), and willingness to participate was 68% (95% CI 24% to 93%; I²=98%). In comparative studies, nurse-led SDM showed no significant difference in LDCT uptake compared with usual care (RR 1.00, 95% CI 0.99 to 1.02; I²=0%), suggesting non-inferiority rather than superiority. Among individuals who completed screening, 81% (95% CI 77% to 85%) had benign or low-risk findings (Lung-RADS [Lung Imaging Reporting and Data System] I/II), and 2% (95% CI 1% to 3%) were diagnosed with early-stage lung cancer, rates consistent with benchmark screening trials. Meta-regression identified female sex as positively associated with uptake (β=0.54, p<0.001), while current tobacco use was negatively associated (β=-0.37, p=0.033). The risk of bias was moderate to serious across studies. CONCLUSIONS: Comparative evidence suggests that nurse-led SDM achieves equivalent LD
引用
- PubMed 高证据 · 肺结节与肺癌筛查：Effects of nurse-led shared decision-making on low-dose CT uptake and screening outcomes in high-risk populations: a systematic review and meta-analysis
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。