Choice between prostatectomy and radiotherapy when men are eligible for both: a randomized controlled trial of usual care vs decision aid
Choice between prostatectomy and radiotherapy when men are eligible for both: a randomized controlled trial of usual care vs decision aid
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DOI：
10.1111/j.1464-410x.2012.11402.x
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发表时间：
2013-04-01
影响因子：
4.5
通讯作者：
Stalmeier, Peep F.
中科院分区：
文献类型：
--
作者：
van Tol-Geerdink, Julia J.;Leer, Jan Willem;Stalmeier, Peep F.
目的探讨适合前列腺切除术和放疗的局限性前列腺癌患者的治疗选择。目的：探讨是否增加患者参与，使用决策辅助，影响治疗选择。患者与方法2008 - 2011年，来自3家不同医院的240例局限性前列腺癌患者入组。他们被选中接受前列腺切除术和外束放疗。近距离放射治疗是大约一半患者的第三种选择。在这项随机对照试验中，患者被随机分为两组，一组只与他们的专家讨论他们的治疗（常规护理组），另一组从研究人员提供的决策辅助中获得额外信息（决策辅助组）。决策辅助是基于文献综述。研究了治疗选择的预测因素。结果治疗选择受辅助决策（P = 0.03）和入院医院（P < 0.001）的影响。决策辅助导致选择近距离放疗的患者较多（P = 0.02），未做出决定的患者较少（P < 0.05）。前列腺切除术仍然是最常用的治疗方法。年龄，肿瘤特征或预处理尿，肠或勃起功能不影响选择在这个选定的组。选择近距离放射治疗的患者更重视手术的便利性和维持勃起功能。结论传统上，手术组和放疗组患者的特征不同，但本组患者的特征不同。同时符合前列腺切除术和放疗条件的男性大多倾向于前列腺切除术，治疗选择受其就诊医院的影响。通过辅助决策，为患者提供基于证据的信息，导致近距离治疗的增加。
ObjectivesTo examine the treatment choice for localized prostate cancer in selected men who were eligible for both prostatectomy and radiotherapy.To examine whether increased patient participation, using a decision aid, affected the treatment choice.Patients and MethodsFrom 2008 to 2011, 240 patients with localized prostate cancer were enrolled from three separate hospitals.They were selected to be eligible for both prostatectomy and external beam radiotherapy. Brachytherapy was a third option for about half of the patients.In this randomized controlled trial, patients were randomized to a group which only discussed their treatment with their specialist (usual care group) and a group which received additional information from a decision aid presented by a researcher (decision aid group). The decision aid was based on a literature review.Predictors of treatment choice were examined.ResultsTreatment choice was affected by the decision aid (P = 0.03) and by the hospital of intake (P < 0.001).The decision aid led to more patients choosing brachytherapy (P = 0.02) and fewer patients remaining undecided (P < 0.05).Prostatectomy remained the most frequently preferred treatment.Age, tumour characteristics or pretreatment urinary, bowel or erectile functioning did not affect the choice in this selected group.Patients choosing brachytherapy assigned more weight to convenience of the procedure and to maintaining erectile function.ConclusionsTraditionally, patient characteristics differ between surgery and radiotherapy groups, but not in this selected group of patients.Men eligible for both prostatectomy and radiotherapy mostly preferred prostatectomy, and the treatment choice was influenced by the hospital they visited.Giving patients evidence-based information, by means of a decision aid, led to an increase in brachytherapy.