Vogel Barbara A, Helmes Almut W, Hasenburg Annette
Department of Rehabilitation Psychology, Institute of Psychology, University of Freiburg, Freiburg, Germany.
Psychooncology. 2008 Feb;17(2):182-9. doi: 10.1002/pon.1215.
This study explored breast cancer patients' preferences and experiences for participation in treatment decision making as well as the concordance between patients' actual and desired decision making. The interplay between depression, anxiety and decision-making preferences was also examined.A consecutive sample of primary breast cancer patients was recruited within a week of either surgery or the beginning of neo-adjuvant chemotherapy in two breast cancer centres in Germany. Women were asked to complete a self-explanatory questionnaire. Most patients (40.2%) of the 137 participants preferred the physician to make the treatment decision. A total of 63.4% were able to fulfil their preferred decision-making role. Breast cancer patients who wanted the physician to make the decision and patients who wanted to make the decision on their own were more likely to have their preferences met than patients who wished to share the decision (p < 0.01). Availability of treatment choice and the level of depression influenced the preferred decision-making preference. Limited concordance between desired and actual decision making of patients with collaborative decision-making preferences suggests the need for better communication and physician training on shared decision making.
本研究探讨了乳腺癌患者参与治疗决策的偏好和经历，以及患者实际决策与期望决策之间的一致性。同时还研究了抑郁、焦虑与决策偏好之间的相互作用。在德国的两个乳腺癌中心，对在手术或新辅助化疗开始后一周内连续招募的原发性乳腺癌患者进行了抽样。女性被要求填写一份无需过多解释的问卷。137名参与者中，大多数患者（40.2%）希望医生做出治疗决策。共有63.4%的患者能够履行其偏好的决策角色。希望医生做决策的乳腺癌患者和希望自己做决策的患者比希望共同做决策的患者更有可能实现其偏好（p<0.01）。治疗选择的可用性和抑郁程度影响了偏好的决策方式。具有共同决策偏好的患者期望决策与实际决策之间的一致性有限，这表明需要加强沟通以及对医生进行关于共同决策的培训。
