Decision-making in rectal and colorectal cancer: systematic review and qualitative analysis of surgeons' preferences
Decision-making in rectal and colorectal cancer: systematic review and qualitative analysis of surgeons' preferences
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DOI：
10.1080/13548506.2016.1220598
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发表时间：
2017-01-01
影响因子：
3.8
通讯作者：
Quintard, Bruno
中科院分区：
文献类型：
--
作者：
Broc, Guillaume;Gana, Kamel;Quintard, Bruno
外科医生在执行建议方面遇到困难，这不仅是因为信息不完整、混乱或相互矛盾，而且也是因为病人越来越多地参与有关其健康的决定。本研究旨在确定哪些共同因素，包括启发性因素，指导外科医生在结肠癌和直肠癌的决策。我们进行了一个系统的文献回顾，外科医生的决策因素有关的结肠癌和直肠癌的治疗。在识别的349篇出版物中，有11篇符合数据分析的条件。使用IRaMuTeQ（R的文本和问卷的多维分析的接口），我们进行了定性分析的显着因素在回顾的研究。应用了几种验证程序来控制结果的稳健性。研究发现，五类因素（即患者、外科医生、治疗、肿瘤和组织线索）影响外科医生的决策。具体而言，在相似性分析中，包括生物医学（例如肿瘤信息）和启发式（例如外科医生的性格因素）标准在内的所有决策标准都向患者的因素年龄收敛。根据这些结果，我们提出了一个解释性模型，显示了启发式标准对医疗问题（即诊断，预后，治疗特征等）的影响。从而影响决策。最后，参与决策的心理社会的复杂性进行了讨论，并提出了在多学科会议中使用的医疗-心理-社会网格。
Surgeons are experiencing difficulties implementing recommendations not only owing to incomplete, confusing or conflicting information but also to the increasing involvement of patients in decisions relating to their health. This study sought to establish which common factors including heuristic factors guide surgeons' decision-making in colon and rectal cancers. We conducted a systematic literature review of surgeons' decision-making factors related to colon and rectal cancer treatment. Eleven of 349 identified publications were eligible for data analyses. Using the IRaMuTeQ (Interface of R for the Multidimensional Analyses of Texts and Questionnaire), we carried out a qualitative analysis of the significant factors collected in the studies reviewed. Several validation procedures were applied to control the robustness of the findings. Five categories of factors (i.e. patient, surgeon, treatment, tumor and organizational cues) were found to influence surgeons' decision-making. Specifically, all decision criteria including biomedical (e.g. tumor information) and heuristic (e.g. surgeons' dispositional factors) criteria converged towards the factor age of patient' in the similarity analysis. In the light of the results, we propose an explanatory model showing the impact of heuristic criteria on medical issues (i.e. diagnosis, prognosis, treatment features, etc.) and thus on decision-making. Finally, the psychosocial complexity involved in decision-making is discussed and a medico-psycho-social grid for use in multidisciplinary meetings is proposed.