Variation in communication of side effects in prostate cancer treatment consultations.
Variation in communication of side effects in prostate cancer treatment consultations.
复制标题
前列腺癌治疗咨询中副作用沟通的变化。
DOI：
10.1038/s41391-024-00806-2
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发表时间：
2024
影响因子：
4.8
通讯作者：
Freedland,StephenJ
中科院分区：
文献类型：
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作者：
Daskivich,TimothyJ;Naser-Tavakolian,Aurash;Gale,Rebecca;Luu,Michael;Friedrich,Nadine;Venkataramana,Abhi;Khodyakov,Dmitry;Posadas,Edwin;Sandler,Howard;Spiegel,Brennan;Freedland,StephenJ
背景治疗副作用（SE）的有效沟通对于局限性前列腺癌的共同决策（SDM）至关重要。我们试图定性描述医生如何沟通SE在consultation.MethodsWe转录50个初始前列腺癌治疗咨询9个多学科的供应商（泌尿科医生，放射肿瘤学家，医学肿瘤学家）在我们的三级转诊，学术中心。编码人员识别描述SE的引文，并使用归纳方法建立通信粒度的层次结构：（1）未提及，（2）仅名称，（3）概括（“高”），（4）无时间点的平均发生率，（5）有时间点的平均发生率，以及（6）精确估计。我们报告了整个咨询过程中每个SE的最细粒度的沟通模式，以及跨专业和肿瘤风险的沟通模式。结果在讨论手术的咨询中（n= 40），勃起功能障碍（艾德）和尿失禁（UI）分别有15%和12%被忽略，未量化（仅命名或概括）分别为47%和30%，记录为无时间轴的平均发生率分别为8%和8%。仅30%和49%的艾德和UI分别用时间轴定量（用时间轴或精确估计的平均发生率）。在讨论放射治疗的会诊中（n= 36），分别有22%、42%和64- 67%的患者忽略了尿路刺激症状、艾德和其他放疗后SE，61%、33%和23- 28%的患者未量化，8%、22%和6- 8%的患者记录为平均发生率，无时间轴。仅3-8%的患者放疗后SE用时间轴定量。专业一致性（但不是肿瘤风险）与更高的粒度的沟通，虽然医生经常未能量化专业一致的SE.ConclusionsSE往往被忽略，不量化，和/或缺乏一个时间轴在我们的样本中的治疗咨询。医生应阐明、量化并为SE分配时间轴，以优化SDM。
BackgroundEffective communication of treatment side effects (SE) is critical for shared decision-making (SDM) in localized prostate cancer. We sought to qualitatively characterize how physicians communicate SE in consultations.MethodsWe transcribed 50 initial prostate cancer treatment consultations across nine multidisciplinary providers (Urologists, Radiation Oncologists, Medical Oncologists) at our tertiary referral, academic center. Coders identified quotes describing SE and used an inductive approach to establish a hierarchy for granularity of communication: (1) not mentioned, (2) name only, (3) generalization(“high”), (4) average incidence without timepoint, (5) average incidence with timepoint, and (6) precision estimate. We reported the most granular mode of communication for each SE throughout the consultation overall and across specialty and tumor risk.ResultsAmong consultations discussing surgery (n= 40), erectile dysfunction (ED) and urinary incontinence (UI) were omitted in 15% and 12%, not quantified (name only or generalization) in 47% and 30%, and noted as average incidence without timeline in 8% and 8%, respectively. In only 30% and 49% were ED and UI quantified with timeline (average incidence with timeline or precision estimate), respectively. Among consultations discussing radiation (n= 36), irritative urinary symptoms, ED, and other post-radiotherapy SE were omitted in 22%, 42%, and 64–67%, not quantified in 61%, 33%, and 23–28%, and noted as average incidence without timeline in 8%, 22%, and 6–8%, respectively. In only 3–8% were post-radiotherapy SE quantified with timeline. Specialty concordance (but not tumor risk) was associated with higher granularity of communication, though physicians frequently failed to quantify specialty-concordant SE.ConclusionsSE was often omitted, not quantified, and/or lacked a timeline in treatment consultations in our sample. Physicians should articulate, quantify, and assign a timeline for SE to optimize SDM.