Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions.
Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions.
复制标题
DOI：
10.1177/0272989x16662841
复制
发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Ubel PA
中科院分区：
文献类型：
--
作者：
Scherr KA;Fagerlin A;Hofer T;Scherer LD;Holmes-Rovner M;Williamson LD;Kahn VC;Montgomery JS;Greene KL;Zhang B;Ubel PA
评估患者偏好和泌尿科医生建议对临床局限性前列腺癌治疗决策的影响。我们招募了257名患有临床局限性前列腺癌（PSA < 20; Gleason 6或7）的男性，他们由4个退伍军人事务医疗中心的泌尿科医生（主要是住院医生和研究员）就诊。我们测量了患者在泌尿科预约之前的基线偏好，包括初始治疗偏好、癌症相关焦虑和性兴趣。在纵向随访中，我们确定了患者接受的治疗。我们使用分层逻辑回归来确定预测接受治疗（积极治疗与积极监测）和泌尿科医生建议的因素。我们还对记录的临床接触进行了定向内容分析，以确定泌尿科医生是否讨论了患者对性的兴趣。患者的初始治疗偏好不能预测接受积极治疗与监测（Δχ2（4）= 3.67，p = 0.45）。相反，接受积极治疗主要是由泌尿科医生的建议预测（Δχ2（2）= 32.81 p <0.001）。反过来，泌尿科医生的建议受到医学因素（年龄和Gleason评分）的严重影响，但与患者偏好无关（Δχ2（6）= 0，p = 1）。泌尿科医生很少讨论患者对性的兴趣（< 15%的预约）。患者的治疗决定主要基于泌尿科医生的建议，而泌尿科医生的建议又基于医学因素（年龄和Gleason评分），而不是患者对治疗方案的相对利弊的个人看法。
To assess the influence of patient preferences and urologist recommendations in treatment decisions for clinically localized prostate cancer. We enrolled 257 men with clinically localized prostate cancer (PSA < 20; Gleason 6 or 7) seen by urologists (primarily residents and fellows) in 4 Veterans Affairs Medical Centers. We measured patients’ baseline preferences prior to their urology appointments, including initial treatment preference, cancer-related anxiety, and interest in sex. In longitudinal follow-up, we determined which treatment patients received. We used hierarchical logistic regression to determine the factors that predicted treatment received (active treatment vs. active surveillance) and urologist recommendations. We also conducted a directed content analysis of recorded clinical encounters to determine if urologists discussed patients’ interest in sex. Patients’ initial treatment preferences did not predict receipt of active treatment versus surveillance (Δχ2 (4) = 3.67, p = .45). Instead, receipt of active treatment was predicted primarily by urologists’ recommendations (Δχ2(2) = 32.81 p < .001). Urologists’ recommendations, in turn, were influenced heavily by medical factors (age and Gleason score) but unrelated to patient preferences (Δχ2 (6) = 0, p = 1). Urologists rarely discussed patients’ interest in sex (< 15% of appointments). Patients’ treatment decisions were based largely upon urologists’ recommendations, which, in turn, were based on medical factors (age and Gleason score) and not on patients’ personal views of the relative pros and cons of treatment alternatives.