Who decides about prostate cancer treatment? A qualitative study
Who decides about prostate cancer treatment? A qualitative study
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DOI：
10.1093/fampra/cmg617
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发表时间：
2003-12-01
期刊：
影响因子：
2.2
通讯作者：
Britten, N
中科院分区：
文献类型：
--
作者：
Cohen, H;Britten, N
背景病人和卫生专业人员之间的共同决策已被提倡为道德和临床可取的。患者参与决策的意愿各不相同，而临床医生则确定了更多参与的实际障碍，如时间和沟通技巧。即使在临床不确定的领域，家长式的治疗决策仍然很常见。患者参与决策的意愿在疾病过程中随着时间的推移而变化，但患者在初次咨询后可能没有机会与他们的专家重新讨论临床决策。为了深入了解最近诊断为局限性前列腺癌的男性的观点，并探讨NHS实践中决策模型的价值。研究设计是半结构化访谈的定性分析。19名最近被诊断为局限性前列腺癌的男性被纳入英国地区综合医院的患者。访谈表明，受访者的治疗计划主要是由他们的临床医生代表他们决定的。虽然最初接受这种家长式的做法，但随着时间的推移，受访者希望重新审视这些决定。患者在共同决策方面的障碍包括害怕对医生表现出不尊重，以及害怕对治疗结果负责。患者随访的结构没有为男性提供进一步讨论治疗决定的机会。在这种情况下，家长式的决策模式仍然是选择的方法。患者积极参与选择护理的意愿随着时间的推移而变化。共同决策的障碍可以从医患关系的性质和临床随访的结构两个方面来确定。
Background. Shared decision-making between patients and health professionals has been promoted as ethically and clinically desirable. Patients vary in their willingness to participate in decision-making, while clinicians identify practical barriers to greater participation, such as time and communication skills. A paternalistic approach to treatment decisions remains common even in an area of clinical uncertainty. The willingness of patients to participate in decision-making varies over time during the course of an illness but patients may not be given the opportunity to revisit clinical decisions with their specialists after the initial consultation.Objectives. To gain an in depth understanding of the perspectives of men recently diagnosed with localized prostate cancer, and to explore the value of decision-making models in the setting of NHS practice.Methods. The study design was a qualitative analysis of semi-structured interviews. Nineteen men recently diagnosed with localized prostate cancer were included from patients attending a British District General Hospital.Results. The interviews suggested that the respondents' treatment plans were mostly decided on their behalf by their clinicians. Whilst initially accepting this paternalistic approach, the interviewees over time wished to revisit the decisions. Patients' barriers to shared decision-making included fear of appearing disrespectful to their doctors and of taking responsibility for the outcome of treatment. The structure of patient follow-up did not afford the men an opportunity to discussion treatment decisions further.Conclusions. The paternalistic decision-making model remains the chosen approach in this situation. The patients' willingness to become actively involved in choosing their care varies over time. Barriers to shared decision-making can be identified both in the nature of the doctor-patient relationship and the structure of the clinical follow-up.