Treatment decision making in early-stage breast cancer: Should surgeons match patients' desired level of involvement?
Treatment decision making in early-stage breast cancer: Should surgeons match patients' desired level of involvement?
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DOI：
10.1200/jco.20.6.1473
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发表时间：
2002-03-15
影响因子：
45.3
通讯作者：
Weeks, JC
中科院分区：
文献类型：
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作者：
Keating, NL;Guadagnoli, E;Weeks, JC
目的：描述早期乳腺癌患者在治疗决策中的期望角色和实际角色，确定患者的实际角色与期望角色匹配的频率，并检查实际角色和期望角色的匹配是否与所接受的治疗类型和满意度相关。患者和方法：我们调查了1081名在马萨诸塞州或明尼苏达州诊断为早期乳腺癌的妇女（应答，70%），了解她们在外科医生治疗决策中的期望和实际角色，并使用逻辑回归来评估实际角色与期望角色的匹配是否与手术类型和满意度相关。结果：大多数患者（64%）希望在决策中发挥协作作用，但只有33%的患者报告说，当他们与外科医生讨论治疗时，实际上发挥了这样的协作作用。总的来说，49%的女性报告的实际角色与她们所期望的角色相匹配，25%的女性的角色比期望的要少，26%的女性的角色比期望的要积极。在调整分析中，报告的实际角色与期望角色相符的患者接受保乳手术的可能性并不比其他患者高（P < 0.05），但这些女性对其治疗选择的满意度（83.5%非常满意；参考）高于角色不理想（72.9%非常满意；P= 0.02）或角色不理想（72.2%非常满意；P= 0.005）。只有大约一半的患者报告在决策中的实际作用与他们报告的期望作用相匹配。这些患者对自己的治疗选择比其他患者更满意，这表明，外科医生努力确定她们参与决策的偏好，并为她们量身定制决策过程，可能会使患有早期乳腺癌的女性受益。
Purpose: To describe desired and actual roles in treatment decision making among patients with early-stage breast cancer, identify how often patients' actual roles matched their desired roles, and examine whether matching of actual and desired roles was associated with type of treatment received and satisfaction.Patients and Methods: We surveyed 1,081 women (response, 70%) diagnosed with early-stage breast cancer in Massachusetts or Minnesota about their desired and actual roles in treatment decision making with their surgeon and used logistic regression to assess whether matching of actual to desired roles was associated with type of surgery and satisfaction.Results: Most patients (64%) desired a collaborative role in decision making, but only 33% reported actually having such a collaborative role when they discussed treatments with their surgeons. Overall, 49% of women reported an actual role that matched the desired role they reported, 25% had a less active role than desired, and 26% had a more active role than desired. In adjusted analyses, patients whose reported actual role matched their desired role were no more likely than others to undergo breast-conserving surgery (P>.2), but these women were more satisfied with their treatment choice (83.5% very satisfied; reference) than those whose role was less active than desired (72.9% very satisfied; P=.02) or more active than desired (72.2% very satisfied; P=.005).Conclusion. Only approximately half of patients reported an actual role in decision making that matched the desired role they reported. These patients were more satisfied with their treatment choice than other patients, suggesting that women with early-stage breast cancer may benefit from surgeons' efforts to identify their preferences for participation in decisions and tailor the decision-making process to them.