Cancer consultation preparation package: Changing patients but not physicians is not enough
Cancer consultation preparation package: Changing patients but not physicians is not enough
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DOI：
10.1200/jco.2004.66.155
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发表时间：
2004-11-01
影响因子：
45.3
通讯作者：
Tattersall, MHN
中科院分区：
文献类型：
--
作者：
Butow, P;Devine, R;Tattersall, MHN
目的：本研究评估了旨在促进患者参与肿瘤会诊的癌症会诊准备包（CCPP）。患者和方法164例癌症患者（有效率67%）在首次肿瘤预约前至少48小时被随机分配接受CCPP或对照小册子。CCPP包括一个问题提示表，关于临床决策和患者权利的小册子，以及对诊所的介绍。对照手册只包括诊所的介绍。医生不知道患者接受了哪种干预。患者在会诊后立即和1个月后填写问卷。对咨询进行录音，逐字抄录，并进行编码。结果除1例患者外，其余患者均阅读了信息。在会诊前，干预组患者的焦虑程度明显高于对照组（平均42 vs 38； P =.04），但随访时焦虑程度相同。据报道，CCPP对家庭成员比对照手册更有用（P = 0.004）。接受干预的患者提出了更多的问题（11个问题vs 7个问题，P = 0.005），更倾向于打断医生（1.01个问题vs 0.71个问题，P = 0.008），更频繁地质疑信息（2次vs 1次，P = 0.05）。接受CCPP的患者（22%）比对照组（35%;P =.06）更不可能达到他们首选的决策方式。结论CCPP影响患者的会诊行为，长期不增加患者的焦虑。然而，在没有医生认可的情况下，这种干预降低了患者参与决策的比例。(C) 2004年由美国临床肿瘤学会出版。
Purpose This study evaluated a cancer consultation preparation package (CCPP) designed to facilitate patient involvement in the oncology consultation.Patients and Methods A total of 164 cancer patients (67% response rate) were randomly assigned to receive the CCPP or a control booklet at least 48 hours before their first oncology appointment. The CCPP included a question prompt sheet, booklets on clinical decision making and patient rights, and an introduction to the clinic. The control booklet contained only the introduction to the clinic. Physicians were blinded to which intervention patients received. Patients completed questionnaires immediately after the consultation and 1 month later. Consultations were audiotaped, transcribed verbatim, and coded.Results All but one patient read the information. Before the consultation, intervention patients were significantly more anxious than were controls (mean, 42 v 38; P =.04),- however anxiety was equivalent at follow-up. The CCPP was reported as being significantly more useful to family members than the control booklet (P =.004). Patients receiving the intervention asked significantly more questions (11 v seven questions; P =.005), tended to interrupt the physician more (1.01 v 0.71 interruptions, P =.08), and challenged information significantly more often (twice v once; P =.05). Patients receiving the CCPP were less likely to achieve their preferred decision making style (22%) than were controls (35%; P =.06).Conclusion This CCPP influences patients' consultation behavior and does not increase anxiety in the long-term. However, this intervention, without physician endorsement, reduced the percentage of patients whose preferred involvement in decision making was achieved. (C) 2004 by American Society of Clinical Oncology.