Variation in Communication of Competing Risks of Mortality in Prostate Cancer Treatment Consultations.
Variation in Communication of Competing Risks of Mortality in Prostate Cancer Treatment Consultations.
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前列腺癌治疗咨询中死亡竞争风险沟通的变化。
DOI：
10.1097/ju.0000000000002675
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Freedland,StephenJ
中科院分区：
文献类型：
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作者：
Daskivich,TimothyJ;Gale,Rebecca;Luu,Michael;Naser-Tavakolian,Aurash;Venkataramana,Abhi;Khodyakov,Dmitry;Anger,JenniferT;Posadas,Edwin;Sandler,Howard;Spiegel,Brennan;Freedland,StephenJ
目的前列腺癌患者更喜欢在共同的决策中对患者的寿命进行具体的定量评估。我们试图描述医生在治疗咨询中如何传达竞争风险的三个组成部分-预期寿命(LE)、癌症预后和与治疗相关的生存利益。材料和方法从来自10个多学科提供者的42名患有低风险和中等风险疾病的男性治疗咨询的记录中确定与LE、癌症预后和与治疗相关的生存利益相关的转换。多位评价者对定性编码的一致意见指出了在整个咨询过程中用于描述每个人的最详细的沟通模式。结果医生经常无法提供针对患者的、对LE和癌症死亡率的定量估计。在17%的会诊中遗漏了LE，17%表示为泛化(如“长”/“短”)，31%表示为粗略年数，17%表示为任意时间点的死亡/存活概率，仅19%表示为具体年数。癌症死亡率在24%的会诊中被遗漏，以概括性方式表示为7%，预期寿命年数为2%，无/任意时间点的概率为40%，仅26%的概率为LE。与治疗相关的生存收益经常被忽略；报告的癌症死亡率在未治疗的情况下为38%，在治疗的情况下为10%，在治疗和未治疗的情况下仅为29%。医生取得了“三连冠”--1)量化癌症死亡率的概率2)有无治疗3)在患者就诊时只有14%。结论医生经常不能充分量化相互竞争的风险。我们推荐“三管齐下”的方法，报告1)癌症死亡的概率2)接受治疗和不接受治疗3)在患者的LE。
PurposeMen with prostate cancer prefer patient-specific, quantitative assessments of longevity in shared decision making. We sought to characterize how physicians communicate the 3 components of competing risks—life expectancy (LE), cancer prognosis and treatment-related survival benefit—in treatment consultations.Materials and MethodsConversation related to LE, cancer prognosis and treatment-related survival benefit was identified in transcripts from treatment consultations of 42 men with low- and intermediate-risk disease across 10 multidisciplinary providers. Consensus of qualitative coding by multiple reviewers noted the most detailed mode of communication used to describe each throughout the consultation.ResultsPhysicians frequently failed to provide patient-specific, quantitative estimates of LE and cancer mortality. LE was omitted in 17% of consultations, expressed as a generalization (eg “long”/”short”) in 17%, rough number of years in 31%, probability of mortality/survival at an arbitrary timepoint in 17% and in only 19% as a specific number of years. Cancer mortality was omitted in 24% of consultations, expressed as a generalization in 7%, years of expected life in 2%, probability at no/arbitrary timepoint in 40% and in only 26% as the probability at LE. Treatment-related survival benefit was often omitted; cancer mortality was reported without treatment in 38%, with treatment in 10% and in only 29% both with and without treatment. Physicians achieved “trifecta”—1) quantifying probability of cancer mortality 2) with and without treatment 3) at the patient’s LE—in only 14% of consultations.ConclusionsPhysicians often fail to adequately quantify competing risks. We recommend the “trifecta” approach, reporting 1) probability of cancer mortality 2) with and without treatment 3) at the patient’s LE.