How Does a Shared Decision-Making (SDM) Intervention for Oncologists Affect Participation Style and Preference Matching in Patients with Breast and Colon Cancer?
How Does a Shared Decision-Making (SDM) Intervention for Oncologists Affect Participation Style and Preference Matching in Patients with Breast and Colon Cancer?
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DOI：
10.1007/s13187-016-1146-7
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发表时间：
2018-06-01
影响因子：
1.6
通讯作者：
Eich, Wolfgang
中科院分区：
文献类型：
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作者：
Bieber, Christiane;Nicolai, Jennifer;Eich, Wolfgang
本研究的目的是评估德国乳腺癌和结肠癌患者样本中患者的首选和感知决策角色和偏好匹配，并调查肿瘤学家的共享决策（SDM）干预如何影响患者的首选和感知决策角色以及偏好匹配的实现。本研究是对SDM干预效果的随机对照试验（RCT）的事后分析。SDM干预是针对医生的12小时SDM培训计划，结合决策板使用。在这项研究中，我们分析了一个亚组的107名乳腺癌和结肠癌患者面临严重的治疗决定，他们提供了关于他们的首选和感知的决策角色（被动，SDM或主动）的特定问卷数据。患者在与肿瘤科医生进行决策相关咨询（t1）后立即填写问卷。这些患者的27名治疗肿瘤学家中有11名在RCT中接受了SDM干预。大多数癌症患者（60%）更喜欢SDM。72%的患者达到了首选和感知决策角色之间的匹配。接受SDM培训的医生治疗的患者在决策中感知到更大的自主性（p < 0.05），更多的患者感知到SDM或积极的角色，但他们的偏好匹配不受影响。肿瘤学家的SDM干预提高了患者的自主性，但没有改善偏好匹配。这突出了众所周知的医生不愿意参与明确的角色澄清。试验注册：德国临床试验注册DRKS 00000539;资金来源：德国癌症援助。
The aims of this study are to assess patients' preferred and perceived decision-making roles and preference matching in a sample of German breast and colon cancer patients and to investigate how a shared decision-making (SDM) intervention for oncologists influences patients' preferred and perceived decision-making roles and the attainment of preference matches. This study is a post hoc analysis of a randomised controlled trial (RCT) on the effects of an SDM intervention. The SDM intervention was a 12-h SDM training program for physicians in combination with decision board use. For this study, we analysed a subgroup of 107 breast and colon cancer patients faced with serious treatment decisions who provided data on specific questionnaires with regard to their preferred and perceived decision-making roles (passive, SDM or active). Patients filled in questionnaires immediately following a decision-relevant consultation (t1) with their oncologist. Eleven of these patients' 27 treating oncologists had received the SDM intervention within the RCT. A majority of cancer patients (60%) preferred SDM. A match between preferred and perceived decision-making roles was reached for 72% of patients. The patients treated by SDM-trained physicians perceived greater autonomy in their decision making (p < 0.05) with more patients perceiving SDM or an active role, but their preference matching was not influenced. A SDM intervention for oncologists boosted patient autonomy but did not improve preference matching. This highlights the already well-known reluctance of physicians to engage in explicit role clarification.Trial Registration: German Clinical Trials Register DRKS00000539; Funding Source: German Cancer Aid.