Supporting Treatment Decision Making in Advanced Cancer: A Randomized Trial of a Decision Aid for Patients With Advanced Colorectal Cancer Considering Chemotherapy
Supporting Treatment Decision Making in Advanced Cancer: A Randomized Trial of a Decision Aid for Patients With Advanced Colorectal Cancer Considering Chemotherapy
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DOI：
10.1200/jco.2010.32.0754
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发表时间：
2011-05-20
影响因子：
45.3
通讯作者：
Tattersall, Martin H. N.
中科院分区：
文献类型：
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作者：
Leighl, Natasha B.;Shepherd, Heather L.;Tattersall, Martin H. N.
目的晚期癌症的决策越来越复杂。我们为正在考虑一线化疗并审查治疗方案、预后信息和毒性的晚期结直肠癌患者开发了一种决策辅助（DA）。我们采用随机试验设计研究了它对患者理解、治疗决策、决策冲突、决策制定、咨询满意度、焦虑和生活质量的影响。207例考虑一线化疗治疗转移性疾病的结直肠癌患者被随机分配接受标准肿瘤内科会诊或DA（带录音的带回家的小册子，由肿瘤学家审查）。参与者完成问卷后咨询，postdecision，1个月later.ResultsIn这项研究中，100例患者被随机分配到对照组，107收到DA.Median年龄的样本为62岁，58%是男性，89%的性能状态为0或1，36%接受了先前的辅助化疗。接受DA治疗的患者表现出对预后、选择和益处的理解有更大的增加，总体理解更高（P <0.001）。决策冲突，治疗决定，并实现参与偏好组之间是相似的。各组的焦虑程度相似，并随着时间的推移而下降。大多数患者有信心在第一次咨询的决定，74%选择化疗，7%的支持性治疗，10%observation.ConclusionThis随机试验的决策援助在晚期癌症表明，它的使用在晚期结直肠癌改善患者的预后，治疗方案，风险和利益的理解，而不增加焦虑。DA可以改善知情同意，即使在晚期癌症环境中也可以通过随机试验进行测试。
PurposeDecision making in advanced cancer is increasingly complex. We developed a decision aid (DA) for patients with advanced colorectal cancer who are considering first-line chemotherapy and reviewing treatment options, prognostic information, and toxicities. We examined its impact on patient understanding, treatment decisions, decisional conflict, decision making, consultation satisfaction, anxiety, and quality of life by using a randomized trial design.Patients and MethodsIn all, 207 patients with colorectal cancer who were considering first-line chemotherapy for metastatic disease were randomly assigned to receive a standard medical oncology consultation or a consultation in which the DA (take-home booklet with audio recording, reviewed by an oncologist) was used. Participants completed questionnaires postconsultation, postdecision, and 1 month later.ResultsIn this study, 100 patients were randomly assigned to the control arm, and 107 received the DA. Median age of the sample was 62 years, 58% were male, 89% had a performance status of 0 or 1, and 36% had received prior adjuvant chemotherapy. Patients receiving the DA demonstrated a greater increase in understanding of prognosis, options, and benefits, with higher overall understanding (P < .001). Decisional conflict, treatment decisions, and achievement of involvement preferences were similar between the groups. Anxiety was similar across groups and decreased over time. Most patients were confident in a decision during the first consultation; 74% chose chemotherapy, 7% supportive care alone, and 10% observation.ConclusionThis randomized trial of a decision aid in advanced cancer showed that its use in advanced colorectal cancer improved patient understanding of prognosis, treatment options, risks, and benefits without increasing anxiety. DAs can improve informed consent and can be tested through randomized trials even in the advanced cancer setting.