Enhancing decision making about participation in cancer clinical trials: development of a question prompt list.
Enhancing decision making about participation in cancer clinical trials: development of a question prompt list.
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DOI：
10.1007/s00520-010-0942-6
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发表时间：
2011-08
期刊：
影响因子：
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通讯作者：
Tattersall M
中科院分区：
文献类型：
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作者：
Brown RF;Shuk E;Leighl N;Butow P;Ostroff J;Edgerson S;Tattersall M
癌症临床试验进展缓慢阻碍了有效的新癌症治疗方法的发展。不良的医患沟通已被确定为低试验收益的关键因素。问题提示列表（QPLs）在促进一般，外科和姑息肿瘤学设置的沟通方面已经证明了重要的承诺。这些简单的患者干预措施尚未在肿瘤临床试验环境中进行过测试。我们的目标是开发用于临床试验的靶向QPL （QPL- ct）。肺癌、乳腺癌和前列腺癌患者（有临床试验经验）或未参加临床试验（未参加试验）被邀请加入焦点小组，以帮助开发和探索QPL-CT的可接受性。对焦点小组进行录音和转录。一个研究小组，包括一名定性数据专家，分析了这些数据，以探讨患者的决策过程和对QPL-CT提示的效用的看法，以帮助试验决策。患者对试验的感知风险与获益的比较评估结果以及患者对医生对试验的推荐的信任程度影响了决策。患者疾病的严重程度仅影响试验初始患者的试验决策。虽然患者可能更喜欢家长式的决策方式，但他们表达了对QPL作为决策辅助的评价。QPL-CT的应用范围超出了实际会诊，包括临床试验讨论前后的作用。
Slow accrual to cancer clinical trials impedes the progress of effective new cancer treatments. Poor physician–patient communication has been identified as a key contributor to low trial accrual. Question prompt lists (QPLs) have demonstrated a significant promise in facilitating communication in general, surgical, and palliative oncology settings. These simple patient interventions have not been tested in the oncology clinical trial setting. We aimed to develop a targeted QPL for clinical trials (QPL-CT). Lung, breast, and prostate cancer patients who either had (trial experienced) or had not (trial naive) participated in a clinical trial were invited to join focus groups to help develop and explore the acceptability of a QPL-CT. Focus groups were audio-recorded and transcribed. A research team, including a qualitative data expert, analyzed these data to explore patients’ decision-making processes and views about the utility of the QPL-CT prompt to aid in trial decision making. Decision making was influenced by the outcome of patients’ comparative assessment of perceived risks versus benefits of a trial, and the level of trust patients had in their doctors’ recommendation about the trial. Severity of a patient’s disease influenced trial decision making only for trial-naive patients. Although patients were likely to prefer a paternalistic decision-making style, they expressed valuation of the QPL as an aid to decision making. QPL-CT utility extended beyond the actual consultation to include roles both before and after the clinical trial discussion.