Cancer Patients' Roles in Treatment Decisions: Do Characteristics of the Decision Influence Roles?
Cancer Patients' Roles in Treatment Decisions: Do Characteristics of the Decision Influence Roles?
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DOI：
10.1200/jco.2009.26.8870
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发表时间：
2010-10-01
影响因子：
45.3
通讯作者：
Weeks, Jane C.
中科院分区：
文献类型：
--
作者：
Keating, Nancy L.;Landrum, Mary Beth;Weeks, Jane C.
目的在决策中扮演更积极角色的患者更满意，可能有更好的健康结果。年轻和受过良好教育的患者有更积极的作用，在决策中，但是否患者的角色不同的决定本身的特点是unknowed.Patients和MethodsWe调查了一个大的，以人口为基础的队列的患者最近诊断为肺癌或结直肠癌的决定，他们的角色，关于手术，放射治疗和/或化疗。我们使用多项逻辑回归来评估决策的特征，包括关于治疗益处的证据，决策是否可能是偏好敏感的，结果在5,383名患者做出的10,939项决策中，38.9%是患者控制的，43.6%是共享的，17.5%由医生控制。当有良好的证据支持治疗时，共享控制最大;当证据不确定时，患者控制最大;当没有证据支持或反对治疗时，医生控制最大（总体P < .001）。转移性癌症的治疗决定往往是更多的医生控制比其他decisions（P < .001）.ConclusionPatients决策的治疗，没有证据支持的好处和决策noncurative治疗报告更多的医生控制，这表明，患者可能不希望的责任，决定治疗，不会治愈他们。当没有证据支持治疗的益处或患者患有无法治愈的绝症时，可能需要更好的共同决策策略。
PurposePatients with more active roles in decisions are more satisfied and may have better health outcomes. Younger and better educated patients have more active roles in decisions, but whether patients' roles in decisions differ by characteristics of the decision itself is unknown.Patients and MethodsWe surveyed a large, population-based cohort of patients with recently diagnosed lung or colorectal cancer about their roles in decisions regarding surgery, radiation therapy, and/or chemotherapy. We used multinomial logistic regression to assess whether characteristics of the decision, including evidence about the treatment's benefit, whether the decision was likely preference-sensitive (palliative therapy for metastatic cancer), and treatment modality, influenced patients' roles in that decision.ResultsOf 10,939 decisions made by 5,383 patients, 38.9% were patient controlled, 43.6% were shared, and 17.5% were physician controlled. When there was good evidence to support a treatment, shared control was greatest; when evidence was uncertain, patient control was greatest; and when there was no evidence for or evidence against a treatment, physician control was greatest (overall P < .001). Decisions about treatments for metastatic cancers tended to be more physician controlled than other decisions (P < .001).ConclusionPatients making decisions about treatments for which no evidence supports benefit and decisions about noncurative treatments reported more physician control, which suggests that patients may not want the responsibility of deciding on treatments that will not cure them. Better strategies for shared decision making may be needed when there is no evidence to support benefit of a treatment or when patients have terminal illnesses that cannot be cured.