Patient treatment preferences in localized prostate carcinoma - The influence of emotion, misconception, and anecdote
Patient treatment preferences in localized prostate carcinoma - The influence of emotion, misconception, and anecdote
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DOI：
10.1002/cncr.22033
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发表时间：
2006-08-01
期刊：
影响因子：
6.2
通讯作者：
Steiner, John F.
中科院分区：
文献类型：
--
作者：
Denberg, Thomas D.;Melhado, Trisha V.;Steiner, John F.
背景。局限性前列腺癌有多种治疗选择，但没有确凿的证据来指导治疗的选择。因此，治疗应反映治愈疾病的可能性和避免治疗相关副作用的愿望之间的权衡。对实际影响患者治疗偏好的因素了解甚少。我们回顾了医疗记录，并对20名在退伍军人事务医院首次咨询泌尿科医生并开始治疗前新诊断的临床局限性前列腺癌的男性进行了深入的半结构化访谈。治疗后6至8个月，我们进行了随访访谈。访谈探讨了对前列腺癌和治疗方案的信念和态度，对诊断的情绪反应，治疗偏好，信息来源以及与泌尿科医生互动的看法。患者的治疗偏好不是基于对各种临床结果的数值风险的仔细评估。相反，恐惧和不确定的感觉促成了对快速治疗的渴望，而特定的偏好受到误解的深刻影响，尤其是关于前列腺切除术的误解，以及其他癌症患者经历的轶事。很少有病人想寻求第二意见。大多数患者接受了符合他们最初偏好的治疗。之后，他们根据同样的误解和治疗审议期间援引的轶事影响来证明他们的选择。对于患有局限性前列腺癌的男性，治疗决策过程将受益于干预措施，这些干预措施可以缓和恐惧情绪和快速治疗的愿望，消除对前列腺癌及其治疗的普遍而强烈的误解，并帮助患者避免过度依赖轶事。
BACKGROUND. Multiple therapeutic options exist for localized prostate carcinoma, without conclusive evidence to guide the choice of treatment. Thus, treatment should reflect trade-offs between the probability of curing disease and the desire to avoid treatment-associated side effects. Factors that actually influence patient treatment preferences are poorly understood.METHODS. We reviewed medical records and carried out in-depth, semi-structured interviews of 20 men with newly-diagnosed, clinically-localized prostate carcinoma in a Veterans Affairs Hospital following their first consultations with urologists and before treatments were initiated. Six to eight months after treatment, we carried out follow-up interviews. Interviews explored beliefs and attitudes about prostate cancer and treatment options, emotional reactions to the diagnosis, treatment preferences, information sources, and perceptions of interactions with urologists.RESULTS. Patient treatment preferences were not based on careful assessments of numerical risks for various clinical outcomes. Instead, feelings of fear and uncertainty contributed to a desire for rapid treatment, and specific preferences were profoundly influenced by misconceptions, especially about prostatectomy, and by anecdotes about the experiences of others with cancer. Few patients wanted to seek second opinions. Most patients received treatments that matched their initial preferences. Afterwards, they justified their choices in terms of the same misconceptions and anecdotal influences invoked during treatment deliberation.CONCLUSIONS. For men with localized prostate carcinoma, the treatment decision-making process would benefit from interventions that moderate feelings of fear and a desire for rapid treatment, dispel common and powerful misconceptions about prostate cancer and its therapies, and help patients avoid over-reliance on anecdotes.