Explicit prognostic disclosure to Asian women with breast cancer: A randomized, scripted video-vignette study (J-SUPPORT1601).
Explicit prognostic disclosure to Asian women with breast cancer: A randomized, scripted video-vignette study (J-SUPPORT1601).
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对患有乳腺癌的亚洲女性进行明确的预后披露：一项随机、有脚本的视频片段研究 (J-SUPPORT1601)。
作者：
Mori M;Fujimori M;van Vliet LM;Yamaguchi T;Shimizu C;Kinoshita T;Morishita-Kawahara M;Inoue A;Inoguchi H;Matsuoka Y;Bruera E;Morita T;Uchitomi Y.
在亚洲，对晚期癌症患者的不良预后不予披露仍然是一种典型的做法。虽然预后沟通的重要性在世界范围内越来越受到认可，但关于明确的预后披露是否会对亚洲晚期癌症患者产生积极影响却知之甚少。本研究的目的是探讨明确的预后沟通对癌症复发患者的影响。MethodsIn this randomized，video‐vignette study，日本女性乳腺癌谁经历了根治性手术的患者复发，无法治愈的乳腺癌和她的肿瘤学家之间的预后沟通的视频。这些视频的不同之处仅在于是否存在明确的预后披露。主要结果是参与者的不确定性（评分从0到10），次要结局包括焦虑（根据状态-特质焦虑量表-状态测量：范围，20 - 80），满意度（患者满意度问卷;范围0 - 10），自我效能（范围，0 - 10），并愿意讨论提前护理计划（范围，1 - 4）。在观看了更多与更少明确披露的视频后，参与者表现出明显更低的不确定性（平均值± SE评分，分别为5.3 ±0.2 vs 5.7 ± 0.2;P= 0.032）和更高的满意度（分别为5.6 ± 0.2 vs 5.2 ± 0.2;P= 0.010），无焦虑增加（状态-特质焦虑量表-状态评分的变化：分别为0.06 ± 0.5 vs 0.6 ± 0.5;P= 0.198）。在自我效能（分别为5.2 ± 0.2 vs 5.0 ± 0.2;P= 0.277）或讨论预先护理计划的意愿（分别为2.7 ± 0.1 vs 2.7 ± 0.1;P= 0.240）方面未观察到显著差异。当被问及亚洲癌症患者的预后时，可以鼓励临床医生尊重他们的意愿，并在适当的情况下明确讨论预后。
BackgroundNondisclosure of a poor prognosis to patients with advanced cancer remains a typical practice in Asia. Although the importance of prognostic communication has increasingly been recognized worldwide, little is known about whether explicit prognostic disclosure positively affects Asian patients with advanced cancer. The objective of this study was to examine the effects of explicit prognostic communication on patients with cancer recurrence.MethodsIn this randomized, video‐vignette study, Japanese women with breast cancer who had undergone curative surgery viewed videos of prognostic communication between a patient with recurrent, incurable breast cancer and her oncologist. The videos differed only in the presence or absence of explicit prognostic disclosure. The primary outcome was participants' uncertainty (rated from 0 to 10), and the secondary outcomes included anxiety (measured on the State‐Trait Anxiety Inventory‐State: range, 20‐80), satisfaction (Patient Satisfaction Questionnaire; range 0‐10), self‐efficacy (range, 0‐10), and willingness to discuss advance care planning (range, 1‐4).ResultsIn total, 105 women participated (mean ± SD age, 53.8 ± 8.2 years). After viewing the video with more versus less explicit disclosure, participants showed significantly lower uncertainty (mean ± SE scores, 5.3 ±0.2 vs 5.7 ± 0.2, respectively;P= .032) and higher satisfaction (5.6 ± 0.2 vs 5.2 ± 0.2, respectively;P= .010) without increasing anxiety (changes in scores on the State‐Trait Anxiety Inventory‐State: 0.06 ± 0.5 vs 0.6 ± 0.5, respectively;P= .198). No significant differences were observed in self‐efficacy (5.2 ± 0.2 vs 5.0 ± 0.2, respectively;P= .277) or willingness to discuss advance care planning (2.7 ± 0.1 vs 2.7 ± 0.1, respectively;P= .240).ConclusionsExplicit prognostic disclosure prompted better outcomes than nondisclosure in Japanese women with breast cancer. When asked about the prognosis by Asian patients with cancer, clinicians may be encouraged to respect their wishes and explicitly discuss the prognosis if deemed appropriate.