van Tol-Geerdink Julia J, Leer Jan Willem, van Lin Emile N J Th, Schimmel Erik C, Huizenga Henk, van Daal Willem A J, Stalmeier Peep F M
Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Int J Radiat Oncol Biol Phys. 2008 Feb 1;70(2):442-8. doi: 10.1016/j.ijrobp.2007.06.058. Epub 2007 Aug 31.
To examine, in prostate cancer patients, the effect of (1) being offered a choice between radiation doses in three-dimensional conformal radiotherapy, and of (2) accepting or declining the possibility to choose.
A total of 150 patients with localized prostate cancer (T1-3N0M0) were offered a choice with a decision aid between two radiation doses (70 and 74 Gy). A control group of 144 patients received a fixed radiation dose without being offered a choice. Data were collected at baseline (before choice), before treatment (after choice), and 2 weeks and 6 months after treatment completion.
Compared with the control group, the involvement group, receiving the decision aid, showed increased participation in decision making (p < 0.001), increased knowledge (p < 0.001), and improved risk perception (p < 0.001); they were more satisfied with the quality of information (p = 0.002) and considered their treatment a more appropriate treatment (p = 0.01). No group differences were found in well-being (e.g., general health, European Organization for Research and Treatment of Cancer quality of life, anxiety). Within the involvement group, accepting or declining the option to choose did not affect well-being either.
Offering a choice of radiation dose, with a decision aid, increased involvement in decision making and led to a better-informed patient. In contrast to earlier suggestions, a strong increase in involvement did not result in improved well-being; and in contrast to clinical concerns, well-being was not negatively affected either, not even in those patients who preferred to leave the decision to their physician. This study shows that older patients, such as prostate cancer patients, can be informed and involved in decision making.
在前列腺癌患者中，研究（1）在三维适形放疗中提供辐射剂量选择的效果，以及（2）接受或拒绝选择可能性的效果。
共有150例局限性前列腺癌（T1 - 3N0M0）患者通过决策辅助工具在两种辐射剂量（70 Gy和74 Gy）之间进行选择。144例患者组成的对照组接受固定辐射剂量且未提供选择。在基线（选择前）、治疗前（选择后）以及治疗完成后2周和6个月收集数据。
与对照组相比，接受决策辅助工具的参与组在决策参与度上有所提高（p < 0.001），知识水平提高（p < 0.001），风险认知改善（p < 0.001）；他们对信息质量更满意（p = 0.002），并认为自己的治疗更合适（p = 0.01）。在幸福感方面（如总体健康、欧洲癌症研究与治疗组织生活质量、焦虑）未发现组间差异。在参与组内，接受或拒绝选择选项对幸福感也没有影响。
通过决策辅助工具提供辐射剂量选择可提高决策参与度，并使患者了解更多信息。与早期观点不同，参与度的大幅提高并未改善幸福感；与临床担忧相反，幸福感也未受到负面影响，即使是那些倾向于将决策留给医生的患者。本研究表明，老年患者，如前列腺癌患者，可以了解情况并参与决策。
