Accuracy of physician assessment of treatment preferences and health status in elderly patients with higher-risk myelodysplastic syndromes
Accuracy of physician assessment of treatment preferences and health status in elderly patients with higher-risk myelodysplastic syndromes
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DOI：
10.1016/j.leukres.2015.05.012
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发表时间：
2015-08-01
影响因子：
2.7
通讯作者：
Efficace, F.
中科院分区：
文献类型：
--
作者：
Caocci, G.;Voso, M. T.;Efficace, F.
高危骨髓增生异常综合征(MDS)很少能治愈，预后也很差。我们调查了医生对患者健康状况感知的准确性和患者参与治疗决策的偏好。我们检查了280名新诊断的高危老年MDS患者和他们的医生。调查工具包括欧洲癌症研究和治疗组织生活质量问卷-核心30(EORTC QLQ-C30)和控制偏好量表。医生对患者参与治疗决策的偏好感知的总体一致性为49%。在36.4%的比较中，存在微小差异，在14.6%的比较中，存在重大差异。44.7%的患者更喜欢被动角色，医生认为他们更喜欢主动或协作角色。缺乏患者对预后信息的要求(P=0.001)和判断患者的健康状况不佳(P=0.036)是与医生对患者参与临床决策程度较低的态度独立相关的因素。有27.5%的人对健康状况表示同意。医生最常高估报告健康状况较低的病人的健康状况，应调查决策辅助工具在具挑战性的高风险MDS环境中的价值，以进一步促进以病人为中心的护理。(C)2015爱思唯尔有限公司。保留所有权利。
Higher-risk myelodysplastic syndromes (MDS) are rarely curable and have a poor prognosis. We investigated the accuracy of physicians' perception of patients' health status and the patients' preferences for involvement in treatment decisions.We examined 280 newly diagnosed higher-risk elderly MDS patients paired with their physicians. Survey tools included the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the Control Preference Scale.Overall concordance was 49% for physician perception of patient preferences for involvement in treatment decisions. In 36.4% of comparisons there were minor differences and in 14.6% there were major differences. In 44.7% of the patients preferring a passive role, physicians perceived them as preferring anactive or collaborative role. Absence of the patient's request for prognostic information (P = 0.001) and judging the patient as having a poor health status (P = 0.036) were factors independently associated with the physicians' attitude toward a lower degree of patient involvement in clinical decisions. Agreement on health status was found in 27.5% of cases. Physicians most frequently tended to overestimate healthstatus of patients who reported low-level health status.The value of decision aid-tools in the challenging setting of higher-risk MDS should be investigated to further promote patient-centered care. (C) 2015 Elsevier Ltd. All rights reserved.