What Is Important When Making Treatment Decisions in Metastatic Breast Cancer? A Qualitative Analysis of Decision-Making in Patients and Oncologists
What Is Important When Making Treatment Decisions in Metastatic Breast Cancer? A Qualitative Analysis of Decision-Making in Patients and Oncologists
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DOI：
10.1634/theoncologist.2018-0711
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发表时间：
2019-10-01
期刊：
影响因子：
5.8
通讯作者：
Knight, Sara J.
中科院分区：
文献类型：
--
作者：
Rocque, Gabrielle B.;Rasool, Aysha;Knight, Sara J.
背景转移性乳腺癌（MBC）是一个理想的环境，共同决策，因为大量的指南为基础的治疗方案具有相似的疗效，但不同的毒性特征。这种定性分析描述了影响MBC治疗决策的患者和提供者因素。材料和方法患者和社区肿瘤学家完成了面对面的采访。学术医学肿瘤学家参加了焦点小组。访谈和焦点小组进行录音，转录，并使用NVivo进行分析。使用基于渥太华框架的先验模型，两个独立的编码器使用恒定比较方法分析转录本。主要的主题和典型的报价摘录。结果参与者包括20例MBC患者，6名社区肿瘤学家和5名学术肿瘤学家。分析病人的访谈显示了一个决策过程，其特征在于以下主题：决策风格，上下文因素和偏好。患者偏好的子主题包括治疗效果、治疗的身体副作用、治疗的情绪副作用、治疗的认知副作用、成本和经济毒性、尖端治疗方案的突出性（临床试验或新批准的药物），治疗后勤和便利，个人和家庭责任，治疗对日常活动的影响，参与自我定义的努力，参加重要活动，追求重要的目标。医生的决定强调药物的特定特征（治疗效果，副作用，成本），而不是患者的喜好，这可能会影响治疗的选择。结论虽然MBC患者和肿瘤医生在做出决定时都考虑了治疗特征，但患者的考虑因素比肿瘤医生更广泛，包括治疗的创新价值和生活责任等背景因素。患者和肿瘤学家之间的观点差异表明，工具的价值，以促进系统的沟通设置MBC的偏好。实践的意义转移性乳腺癌（MBC）患者和肿瘤学家都强调在做出治疗决定时疗效和身体副作用的重要性。然而，患者在做出治疗决定时的其他考虑因素更为广泛，包括治疗的后勤、个人和家庭责任以及参加重要活动的能力等背景因素。此外，个体患者在治疗决策中需要考虑的优先事项方面存在很大差异。患者和肿瘤学家之间的观点差异表明工具的价值，以促进系统的启发的喜好和沟通的这些喜好，肿瘤学家整合到决策MBC。
Background Metastatic breast cancer (MBC) is an ideal environment for shared decision-making because of the large number of guideline-based treatment options with similar efficacy but different toxicity profiles. This qualitative analysis describes patient and provider factors that influence decision-making in treatment of MBC. Materials and Methods Patients and community oncologists completed in-person interviews. Academic medical oncologists participated in focus groups. Interviews and focus groups were audio-recorded, transcribed, and analyzed using NVivo. Using an a priori model based on the Ottawa Framework, two independent coders analyzed transcripts using a constant comparative method. Major themes and exemplary quotes were extracted. Results Participants included 20 patients with MBC, 6 community oncologists, and 5 academic oncologists. Analysis of patient interviews revealed a decision-making process characterized by the following themes: decision-making style, contextual factors, and preferences. Patient preference subthemes include treatment efficacy, physical side effects of treatment, emotional side effects of treatment, cognitive side effects of treatment, cost and financial toxicity, salience of cutting-edge treatment options (clinical trial or newly approved medication), treatment logistics and convenience, personal and family responsibilities, treatment impact on daily activities, participation in self-defining endeavors, attending important events, and pursuing important goals. Physician decisions emphasized drug-specific characteristics (treatment efficacy, side effects, cost) rather than patient preferences, which might impact treatment choice. Conclusion Although both patients with MBC and oncologists considered treatment characteristics when making decisions, patients' considerations were broader than oncologists', incorporating contextual factors such as the innovative value of the treatment and life responsibilities. Differences in perspectives between patients and oncologists suggests the value of tools to facilitate systematic communication of preferences in the setting of MBC. Implications for Practice Both patients with metastatic breast cancer (MBC) and oncologists emphasized importance of efficacy and physical side effects when making treatment decisions. However, other patient considerations for making treatment decisions were broader, incorporating contextual factors such as the logistics of treatments, personal and family responsibilities, and ability to attend important events. Furthermore, individual patients varied substantially in priorities that they want considered in treatment decisions. Differences in perspectives between patients and oncologists suggest the value of tools to facilitate systematic elicitation of preferences and communication of those preferences to oncologists for integration into decision-making in MBC.