Patient preferences versus physician perceptions of treatment decisions in cancer care
Patient preferences versus physician perceptions of treatment decisions in cancer care
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DOI：
10.1200/jco.2001.19.11.2883
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发表时间：
2001-06-01
影响因子：
45.3
通讯作者：
Benisch-Tolley, S
中科院分区：
文献类型：
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作者：
Bruera, E;Sweeney, C;Benisch-Tolley, S
目的：检查患者的偏好以及医生对姑息治疗决策和沟通的这些偏好的看法。患者和方法：在姑息治疗门诊进行初步评估后，对78名可评估的癌症患者进行了医疗决策偏好（dmp）的前瞻性研究。通过问卷调查评估dmp，使用5种可能的选择，从1（患者倾向于做出治疗决定）到5（患者倾向于医生做出决定）。此外，还评估了医生对这种偏好的看法。结果：78例患者中有30例（38%）医患完全一致；当五个原始类别重新组合以涵盖主动，共享和被动决策时，78例中有35例（45%）存在一致性。医生和患者之间一致性的kappa系数较差，简单kappa为0.14(95%置信限，-0.01至0.30)，加权kappa为0.17(95%置信区间[CI]， 0.00至0.34)（根据三个重新分组的类别计算）。78名患者中分别有16名（20%）、49名（63%）和13名（17%）选择了主动、固定和被动的dmp， 78名医生中分别有23名（29%）、30名（39%）和25名（32%）选择了主动、固定和被动的dmp。大多数患者（49例[63%]/ 78例；95% CI, 0.51 - 0.74）倾向于与医生共享治疗方法。医生们预测，患者更倾向于一种不太常见的治疗方法。患者的年龄和性别对DMP没有显著影响，结论：需要个体化的方法，每个患者都应该对DMP进行前瞻性评估。
Purpose: To examine patient preferences as well as physician perceptions of these preferences for decision making and communication in palliative care.Patients and Methods: Medical decision-making preferences (DMPs) were prospectively studied in 78 assessable cancer patients after initial assessment at a palliative care outpatient clinic. DMPs were assessed with a questionnaire using five possible choices ranging from 1 (patient prefers to make the treatment decision) to 5 (patient prefers the physician to make the decision). In addition, the physician's perception of this preference was assessed.Results: Full concordance between the physician and the patient was seen in 30 (38%) of 78 cases; when the five original categories were recombined to cover active, shared, and passive decision making, there wets concordance in 35 (45%) of 78 cases. The kappa coefficient for agreement between physician and patient was poor at 0.14 (95% confidence limit, -0.01 to 0.30) for simple kappa and 0.17 (95% confidence interval [CI], 0.00 to 0.34) for weighted kappa (calculated on the three regrouped categories). Active, shored, and passive DMPs were chosen by 16 (20%) of 78, 49 (63%) of 78, and 13 (17%) of 78 patients, and by 23 (29%) of 78, 30 (39%) of 78, and 25 (32%) of 78 physicians, respectively. The majority of patients (49 [63%] of 78; 95% CI, 0.51 to 0.74) preferred a shared approach with physicians. Physicians predicted that patients preferred a less shared approach than they in fact did. Patient age or sex did not significantly alter DMP,Conclusion: An individual approach is needed and each patient should be assessed prospectively for DMP.