Challenges in shared decision making in advanced cancer care: a qualitative longitudinal observational and interview study
Challenges in shared decision making in advanced cancer care: a qualitative longitudinal observational and interview study
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DOI：
10.1111/hex.12434
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发表时间：
2017-02-01
影响因子：
3.2
通讯作者：
Pasman, H. Roeline W.
中科院分区：
文献类型：
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作者：
Brom, Linda;De Snoo-Trimp, Janine C.;Pasman, H. Roeline W.
背景在生命的最后阶段，患者的偏好和期望应该在治疗决策中得到考虑。共同决策（SDM）被认为是一种让患者在决策中发挥核心作用的方法。SDM是如何在临床实践中使用先进的cancer care.ObjectiveTo研究SDM的步骤是否以及如何可以认识到在决策有关第二和第三线chemotherapy.Methods的14个晚期癌症患者进行了随访，随着时间的推移，使用面对面的深入访谈和观察患者的门诊访视。访谈和门诊诊所的访问中，治疗方案进行了讨论或作出的决定逐字转录和分析使用开放coding.Results患者满意的决策过程中，但SDM的步骤几乎没有看到在日常实践中。医生对现有治疗方案的认识有限，没有以平等的方式进行讨论。患者的愿望和关注没有明确评估，这导致不同的期望改善生存从后续线的chemotherapy.Conclusion达到SDM在日常实践中，医生应该创造意识的所有治疗方案，包括放弃治疗，并沟通的利益和危害的风险。需要公开和诚实的沟通，讨论患者的期望和担忧。通过这种方式，可以促进生命最后阶段的艰难决策过程，并加强对特定患者最佳护理的关注。
Background Patients' preferences and expectations should be taken into account in treatment decision making in the last phase of life. Shared decision making (SDM) is regarded as a way to give the patient a central role in decision making. Little is known about how SDM is used in clinical practice in advanced cancer care.Objective To examine whether and how the steps of SDM can be recognized in decision making about second-and third-line chemotherapy.Methods Fourteen advanced cancer patients were followed over time using face-to-face in-depth interviews and observations of the patients' out-clinic visits. Interviews and outpatient clinic visits in which treatment options were discussed or decisions made were transcribed verbatim and analysed using open coding.Results Patients were satisfied with the decision-making process, but the steps of SDM were barely seen in daily practice. The creation of awareness about available treatment options by physicians was limited and not discussed in an equal way. Patients' wishes and concerns were not explicitly assessed, which led to different expectations about improved survival from subsequent lines of chemotherapy.Conclusion To reach SDM in daily practice, physicians should create awareness of all treatment options, including forgoing treatment, and communicate the risk of benefit and harm. Open and honest communication is needed in which patients' expectations and concerns are discussed. Through this, the difficult process of decision making in the last phase of life can be facilitated and the focus on the best care for the specific patient is strengthened.