The role of health-related quality of life outcomes in clinical decision making in surgery for esophageal cancer: A systematic review
The role of health-related quality of life outcomes in clinical decision making in surgery for esophageal cancer: A systematic review
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DOI：
10.1245/s10434-008-0042-8
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发表时间：
2008-09-01
影响因子：
3.7
通讯作者：
Blazeby, J. M.
中科院分区：
文献类型：
--
作者：
Parameswaran, R.;McNair, A.;Blazeby, J. M.
背景资料：食道切除术治疗癌症提供了治愈的机会，但与发病率相关，至少会暂时降低健康相关的生活质量（HRQL），5年生存率约为30%。本研究评估了如何以及是否HRQL结果有助于手术decisionmaking.Methods：一项系统性综述确定了随机试验和纵向和横断面研究，评估HRQL食管切除术后多维有效的问卷调查。文章由两名评审员独立评估，HRQL在临床决策中的价值分为三种方式：（1）根据预定义的标准评估HRQL方法的质量;（2）HRQL结果对治疗建议和/或知情同意的影响;（3）在方法学上稳健的研究中食管癌切除术后的HRQL。确定了18篇出版物，其中16篇（89%）被归类为具有稳健的HRQL设计。在这些研究中，3项得出结论认为HRQL影响治疗建议和11项（包括前3项）患者知情同意。其余5篇论文设计良好，但作者没有使用HRQL来影响治疗建议或知情同意。食管切除术后，患者报告的主要恶化，在大多数方面的HRQL与缓慢recovery.Conclusion：HRQL的结果是相关的手术决策。告知知情同意和临床实践需要向患者传达HRQL结果的方法。
Background: Esophagectomy for cancer offers a chance of cure but is associated with morbidity, at least a temporary reduction in health-related quality of life (HRQL), and a 5-year survival of approximately 30%. This research evaluated how and whether HRQL outcomes contribute to surgical decision making.Methods: A systematic review identified randomized trials and longitudinal and cross-sectional studies that assessed HRQL after esophagectomy with multidimensional validated questionnaires. Articles were independently evaluated by two reviewers, and the value of HRQL in clinical decision making was categorized in three ways: (1) the assessment of the quality of HRQL methodology according to predefined criteria; (2) the influence of HRQL outcomes on treatment recommendations and/or informed consent; and (3) the HRQL after esophagectomy for cancer in methodologically robust studies.Results: Eighteen publications were identified, of which 16 (89%) were categorized as having robust HRQL design. Of these studies, 3 concluded that HRQL influenced treatment recommendations and 11 (including the former 3) informed patient consent. The remaining five papers were well designed, but the authors did not use HRQL to influence treatment recommendations or informed consent. After esophagectomy, patients report major deterioration in most aspects of HRQL with slow recovery.Conclusion: HRQL outcomes are relevant to surgical decision making. Methods to communicate HRQL outcomes to patients are required to inform consent and clinical practice.