Patient-physician concordance: Preferences, perceptions, and factors influencing the breast cancer surgical decision
Patient-physician concordance: Preferences, perceptions, and factors influencing the breast cancer surgical decision
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DOI：
10.1200/jco.2004.09.069
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发表时间：
2004-08-01
影响因子：
45.3
通讯作者：
Wilkins, EG
中科院分区：
文献类型：
--
作者：
Lanz, NK;Wren, PA;Wilkins, EG
目的探讨患者对参与乳腺癌治疗决策的偏好，以及患者和医生对决策角色的看法的一致性。人口统计学和社会心理特征对患者决策作用的影响也进行了研究。患者和方法从一所大学乳腺癌治疗中心招募了1期或11期乳腺癌患者，她们要么是乳房切除术，要么是乳房肿瘤切除术。在会见外科肿瘤学家之前，以及在做出治疗决定之后，手术干预之前，对患者进行访谈。会诊后获得临床医生的答复。结果101名参与者一般为白人（97%），已婚（80%），受过良好教育。他们报告有中度的抑郁和焦虑，但在与医生沟通时有良好的社会支持和自我效能。在咨询之前，47%的女性报告说她们更喜欢共同决策；之后，61%的人认为他们对这个决定负有主要责任。只有38%的患者同意医生对如何做出治疗决定的评估。在回归分析中，高等教育程度与患者的首选控制水平显著相关（P = 0.01）。自我效能感高的女性倾向于更积极的决策角色（P = .08）。患者对决策的偏好不影响医患接触的时间，但更多的影响确实增加了满意度。结论患者偏好与患者感知、患者与医生感知在治疗决策中的一致性有限，提示在乳腺癌患者的关键治疗过程中，患者与临床医生之间需要更好的沟通。(C) 2004年由美国临床肿瘤学会出版。
Purpose This study explored patient preferences for involvement in the breast cancer treatment decision and concordance between patients' and physicians' views on decisional role. The impact of demographic and psychosocial characteristics on patients' decisional role was also examined.Patients and Methods Women with stage I or 11 breast cancer who were candidates for either mastectomy or lumpectomy were recruited from a university breast cancer treatment center. Patient interviews were obtained before meeting the surgical oncologist and again after the treatment decision was made but before surgical intervention. Clinician responses were obtained after the consultation.Results The 101 participants were generally white (97%), married (80%), and well-educated. They reported moderate levels of depression and anxiety but good social support and self-efficacy in communicating with their physician. Before the consultation, 47% of women reported a preference for shared decision making; afterwards, 61% felt they had primary responsibility for the decision. Only 38% of patients agreed with the physician's assessment of how the treatment decision was made. In regression analyses, higher education was significantly associated with patients' preferred level of control (P = .01). There was a trend toward women with greater self-efficacy desiring more active decisional roles (P = .08). Patient preference for decision making did not impact time in the patient-physician encounter, but more influence did increase satisfaction.Conclusion Limited concordance between patient preference and patient perception and between patient and physician perception in how the treatment decision was made suggests the need for better communication between patient and clinician during a critical treatment encounter for breast cancer patients. (C) 2004 by American Society of Clinical Oncology.