Whelan Timothy, Levine Mark, Willan Andrew, Gafni Amiram, Sanders Ken, Mirsky Doug, Chambers Shelley, O'Brien Mary Ann, Reid Susan, Dubois Sacha
Department of Medicine, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.
JAMA. 2004 Jul 28;292(4):435-41. doi: 10.1001/jama.292.4.435.
The long-term results of randomized trials have demonstrated equivalent survival rates for mastectomy and breast-conserving therapy for the treatment of early stage breast cancer. Consequently, the choice of treatment should be based on a patient's preferences.
To evaluate the impact of a decision aid regarding the different surgical treatment options on patient decision making.
A cluster randomized trial for which general surgeons in the communities of central-west, and eastern Ontario, Canada, were randomly assigned to use the decision aid or not in the surgical consultation. Patients received the decision aid or not based on the surgeon seen.
Twenty surgeons participated in the study. Of the 208 eligible women with newly diagnosed clinical stage I or II breast cancer seen by study surgeons, 201 agreed to be evaluated: 94 were assigned to the decision board and 107 to usual practice. Patients were recruited from November 1999 to April 2002.
The decision board is a decision aid designed to help physicians inform their patients about different treatment options and to enable patients to express a preference for treatment.
Patient knowledge about the surgical treatment of breast cancer; decisional conflict; satisfaction with decision making; and the treatment decision following the consultation.
Patients in the decision board group had higher knowledge scores about their treatment options (66.9 vs 58.7; P<.001), had less decisional conflict (1.40 vs 1.62, P =.02), and were more satisfied with decision making (4.50 vs 4.32, P =.05) following the consultation. Patients who used the decision board were more likely to choose BCT (94% vs 76%, P =.03).
The decision board was helpful in improving communication and enabling women to make a choice regarding treatment. Such instruments should be considered by surgeons when communicating the different surgical options to women with breast cancer.
随机试验的长期结果表明，在治疗早期乳腺癌方面，乳房切除术和保乳治疗的生存率相当。因此，治疗方案的选择应基于患者的偏好。
评估关于不同手术治疗方案的决策辅助工具对患者决策的影响。
一项整群随机试验，加拿大安大略省中西部和东部社区的普通外科医生被随机分配在手术咨询中使用或不使用决策辅助工具。患者根据所看的外科医生接受或不接受决策辅助工具。
20名外科医生参与了该研究。在研究外科医生接诊的208名新诊断为临床I期或II期乳腺癌的合格女性中，201名同意接受评估：94名被分配到决策辅助组，107名接受常规治疗。患者于1999年11月至2002年4月招募。
决策辅助工具是一种旨在帮助医生向患者介绍不同治疗方案并使患者能够表达治疗偏好的决策辅助工具。
患者对乳腺癌手术治疗的了解；决策冲突；对决策的满意度；以及咨询后的治疗决策。
决策辅助组的患者对其治疗方案的知识得分更高（66.9对58.7；P<0.001），决策冲突更少（1.40对1.62，P = 0.02），并且在咨询后对决策更满意（4.50对4.32，P = 0.05）。使用决策辅助工具的患者更有可能选择保乳治疗（94%对76%，P = 0.03）。
决策辅助工具有助于改善沟通并使女性能够就治疗做出选择。外科医生在向乳腺癌女性传达不同手术方案时应考虑使用此类工具。
