AGE AND CLINICAL DECISION-MAKING IN ONCOLOGY PATIENTS
AGE AND CLINICAL DECISION-MAKING IN ONCOLOGY PATIENTS
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DOI：
10.1093/jnci/86.23.1766
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发表时间：
1994-12-07
期刊：
影响因子：
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通讯作者：
LESLIE, WT
中科院分区：
文献类型：
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作者：
YELLEN, SB;CELLA, DF;LESLIE, WT
背景：年龄歧视是一种文化偏见，可能会不适当地引导肿瘤学家不推荐对老年患者进行积极治疗。老年患者可能在多大程度上倾向于侵袭性较低的癌症治疗尚不清楚。我们缺乏对患者个人治疗偏好的了解可能会使这种偏见永久化。目的：我们进行了一项研究，以确定1)年龄是否会影响患者对癌症治疗的接受程度，2)与年轻患者相比，老年患者是否更有可能为了维持生活质量而牺牲更多的生存时间。方法：采用访谈的形式，244名在三级癌症护理中心接受治疗的所有年龄段的癌症患者阅读了两组假设的小插曲。第一组由四个小插曲组成，根据疾病阶段和治疗毒性而有所不同。患者被要求就提高治愈率或延长生存期的不同水平给予的治疗做出假设决定。第二组小插曲推定接受癌症治疗。在每个片段中，对比了两种假设的治疗方法(轻度和重度)，这些治疗具有不同的一年生存概率。患者从副作用轻微和严重的治疗中转变偏好的时间点是依赖的衡量标准。混合方差分析(ANOVA)程序(F检验)评估了年龄(
Background: Ageism is a cultural bias that might inappropriately steer oncologists away from recommending aggressive treatments for older patients. The extent to which older patients might prefer less aggressive cancer therapies is unknown. Our lack of knowledge about patients' personal preferences for therapy may perpetuate this bias. Purpose: We conducted a study to determine 1) if age influences patient acceptance of cancer therapy and 2) if the older patients would be more or less likely to trade increased survival for maintaining quality of life than their younger counterparts. Methods: Using an interview format, 244 cancer patients of all ages treated at a tertiary care cancer center read two sets of hypothetical vignettes. The first set consisted of four vignettes that varied in terms of stage of disease and treatment toxicity. Patients were asked to make hypothetical decisions about treatment given with respect to varying levels of either increasing cure or extending survival. The second set of vignettes presumed acceptance of cancer therapy. Within each vignette, two hypothetical treatments (mild versus severe) with different probabilities of 1-year survival were contrasted. The point at which patients shifted preferences from a treatment with mild versus severe side effects was the dependent measure. Mixed analysis of variance (ANOVA) procedures (F test) assessed the impact of age (