Irwin E, Arnold A, Whelan T J, Reyno L M, Cranton P
McMaster University, School of Nursing, OCTRF Hamilton Regional Cancer Centre, Hamilton, Ontario, Canada.
Patient Educ Couns. 1999 Jul;37(3):283-91. doi: 10.1016/s0738-3991(98)00117-7.
The primary objective of this study was to develop a decision aid which would encourage and assist patients to become involved in treatment decision making, and help clinicians to objectively educate patients about the benefits and risks of adjuvant chemotherapy for breast cancer. A secondary objective was to investigate the factors influencing this treatment decision-making process for women when choosing between adriamycin and cyclophosphamide (AC) versus cyclophosphamide, methotrexate and 5-fluorouracil (CMF) chemotherapy.
An educational visual instrument called a Decision Board was developed consisting of written and graphical material. The Decision Board displays general information about chemotherapy and detailed information about each chemotherapy regimen, including the schedule and side effects, and was presented to patients with a scripted standardized oral explanation. The instrument was evaluated in 46 premenopausal women newly diagnosed with node-positive breast cancer. Following presentation of the board, the patients were given a take home version to review and asked to return 1-2 weeks later with a decision. During the second visit each patient was asked to complete a questionnaire regarding demographics, learning and comprehension, treatment preference, and factors influencing their decision.
Recall of information was acceptable (> or = 80%). The Decision Board was found helpful by all, but the level of difficulty with decision making was variable. Out of 46 women, 23 women chose AC, 21 chose CMF, and two chose no treatment. The major factors affecting treatment preference were related to the impact on quality of life, the length of therapy, and the side effects, in particular, vomiting and alopecia.
The Decision Board appears to be a valuable educational tool that enables patients to become well-informed and directly involved in their treatment decisions.
本研究的主要目的是开发一种决策辅助工具，以鼓励并帮助患者参与治疗决策，并帮助临床医生客观地向患者介绍乳腺癌辅助化疗的益处和风险。次要目的是调查在阿霉素和环磷酰胺（AC）与环磷酰胺、甲氨蝶呤和5-氟尿嘧啶（CMF）化疗之间进行选择时，影响女性这一治疗决策过程的因素。
开发了一种名为决策板的教育可视化工具，它由书面和图形材料组成。决策板展示了化疗的一般信息以及每种化疗方案的详细信息，包括疗程和副作用，并通过标准化的口头讲解向患者进行介绍。该工具在46名新诊断为淋巴结阳性乳腺癌的绝经前女性中进行了评估。在展示决策板后，给患者发放一份带回家的版本以供复习，并要求她们在1至2周后带着决定返回。在第二次就诊时，要求每位患者完成一份关于人口统计学、学习和理解、治疗偏好以及影响其决策的因素的问卷。
信息回忆情况良好（≥80%）。所有患者都认为决策板很有帮助，但决策的难度程度因人而异。在46名女性中，23名女性选择了AC，21名选择了CMF，2名选择不进行治疗。影响治疗偏好的主要因素与对生活质量的影响、治疗时长以及副作用有关，尤其是呕吐和脱发。
决策板似乎是一种有价值的教育工具，能使患者充分了解信息并直接参与其治疗决策。
