Revisiting Expectations in an Era of Precision Oncology
Revisiting Expectations in an Era of Precision Oncology
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DOI：
10.1634/theoncologist.2017-0269
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发表时间：
2018-03-01
期刊：
影响因子：
5.8
通讯作者：
Shuman, Andrew G.
中科院分区：
文献类型：
--
作者：
Marchiano, Emily J.;Birkeland, Andrew C.;Shuman, Andrew G.
随着我们进入精准医学和靶向治疗转移性癌症的时代，我们在制定明确的指导方针、法规和实施策略时，对患者和提供者都面临着新的挑战。这一挑战的关键在于，晚期癌症患者在参与旨在产生可推广知识的临床试验时，可能对个人利益抱有不成比例的期望。患者和医生的治疗目标可能不一致，必须解决他们不同看法的和解。然而，当精确医疗的目标——个性化反应——加剧了我们无法预测任何单个患者的结果时，管理患者的期望尤其具有挑战性。因此，精准医疗知情同意程序必须直接解决这一问题。我们面临的挑战是，诚实、清晰和富有同情心地让患者群体参与一个知情同意过程，以回应他们的脆弱性，以及不断变化的指征和证据。这个时代需要不断地重新评估双方的期望和目标。
As we enter an era of precisionmedicine and targeted therapies in the treatment of metastatic cancer, we face new challenges for patients and providers alike as we establish clear guidelines, regulations, and strategies for implementation. At the crux of this challenge is the fact that patients with advanced cancer may have disproportionate expectations of personal benefit when participating in clinical trials designed to generate generalizable knowledge. Patient and physician goals of treatment may not align, and reconciliation of their disparate perceptions must be addressed. However, it is particularly challenging to manage a patient's expectations when the goal of precision medicine-personalized response-exacerbates our inability to predict outcomes for any individual patient. The precisionmedicine informed consent process must therefore directly address this issue. We are challenged to honestly, clearly, and compassionately engage a patient population in an informed consent process that is responsive to their vulnerability, as well as everevolving indications and evidence. This era requires a continual reassessment of expectations and goals from both sides of the bed.