Evaluation of a shared decision making program for women suspected to have a genetic predisposition to breast cancer: Preliminary results
Evaluation of a shared decision making program for women suspected to have a genetic predisposition to breast cancer: Preliminary results
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DOI：
10.1177/0272989x9901900302
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发表时间：
1999-07-01
影响因子：
3.6
通讯作者：
Van Daal, WAJ
中科院分区：
文献类型：
--
作者：
Stalmeier, PFM;Unic, IJ;Van Daal, WAJ
背景怀疑有乳腺癌遗传易感性的妇女面临着定期乳腺癌筛查和预防性乳房切除术之间的艰难选择。作者开发了一个共享决策程序（SDMP）来支持这一决策。目标。评估SDMP的实用性、有益效果和患者满意度。设计。采用单组前测后测设计。措施。评估决策不确定性、决策负担、主观知识和风险理解能力。获得了与乳腺癌关注相关的概念、参与计划的愿望、满意度、计划可接受性以及对计划信息的情绪反应的附加测量。结果。72名女性参加了测试，其中大多数人正在等待基因测试结果。SDMP降低了决策不确定性（效应量d = 0.37）和决策负担（d = 0.41）。主观知识（平均d = 0.94）和风险理解能力均有提高。这些妇女对社会民主党感到满意，认为其理由可以接受。对信息有强烈情绪反应的女性从SDMP中获益较少，而有强烈参与决策意愿的女性受益更多。结论。有必要向患者提供更多的信息，特别是关于预防性乳房切除术和基因携带者的信息。无论是否知道遗传状况，都观察到有益的效果，这表明有关治疗方案的信息应该；DNA测试一开始就可以使用。参与欲望越强的女性心理结果越好，可能是因为参与欲望是情绪稳定的特征。
Background Women suspected to have a genetic predisposition to breast cancer face the difficult choice between regular breast cancer screening and prophylactic mastectomy. The authors developed a shared decision making program (SDMP)to Support this decision. Objectives. To evaluate the SDMP in terms of practicality, beneficial effects, and patient satisfaction. Design. A one-group pretest-posttest design was used. Measures. Decision uncertainty, decision burden, subjective knowledge, and risk comprehension were assessed before and after the SDMP. Additional measures were obtained for concepts related to breast cancer concern, desire to participate in the program, satisfaction, program acceptability, and emotional reaction to the program information. Results. Seventy-two women, most of whom were awaiting the genetic test results, participated. Decision uncertainty (effect size d = 0.37) and decision burden (d = 0.41) were reduced by the SDMP. Subjective knowledge (averaged d = 0.94) and risk comprehension were improved. The women were satisfied with the SDMP and found its rationale acceptable. Women who had strong emotional reactions to the information benefited less from the SDMP, whereas women with strong desires to participate in the decision benefited more. Conclusions. There is a need to give patients more information, especially about prophylactic mastectomy and among gene carriers. Beneficial effects were observed irrespective of whether genetic status was known, suggesting that information concerning treatment options should be;made available as soon as DNA testing begins. The better psychological outcomes of women with stronger desires to participate may arise because the desire to participate is characteristic of emotional stability.