Shepherd Heather L, Tattersall Martin H N, Butow Phyllis N
Medical Psychology Research Unit, Department of Cancer Medicine, School of Psychology, University of Sydney, New South Wales 2006, Australia.
J Clin Oncol. 2008 Apr 1;26(10):1724-31. doi: 10.1200/JCO.2007.13.5566.
Cancer physicians report high comfort with shared decision making but a lower frequency of using this approach in practice. Information regarding physicians' perceptions of what helps and what hinders patient involvement in decision making may facilitate understanding of this discrepancy.
We surveyed 604 Australian cancer physicians treating breast, colorectal, gynecologic, hematologic, or urologic cancer to investigate barriers and facilitators to reaching treatment decisions with their patients and their support of strategies to encourage patient involvement and reflection on treatment options. Factor analysis and regression analyses were used to investigate relationships between variables and identify predictors of greater reporting of barriers to sharing treatment decisions with patients.
Insufficient information at the first consultation (28.9%) and insufficient time (28.4%) were the most frequently reported barriers to reaching treatment decisions with patients. Multivariate analysis revealed that less experienced physicians more commonly reported system barriers (P = .00). Patients trusting their physician and being accompanied at the consultation were most helpful to reaching a treatment decision. Providing written information about treatment options, making a further appointment to reach a decision, encouraging the patient to speak with their family physician and treatment team, and the presence of a third person during the consultation were felt to encourage involvement and reflection on treatment decisions.
Cancer physicians experience difficulties when reaching treatment decisions with their patients. Interventions and strategies that physicians support are required to enhance patient involvement in reaching a treatment decision.
肿瘤医生表示对共同决策有较高的舒适度，但在实际操作中使用这种方法的频率较低。了解医生对有助于和阻碍患者参与决策的因素的看法，可能有助于理解这种差异。
我们对604名治疗乳腺癌、结直肠癌、妇科癌、血液癌或泌尿系统癌的澳大利亚肿瘤医生进行了调查，以探究与患者共同做出治疗决策的障碍和促进因素，以及他们对鼓励患者参与和思考治疗方案的策略的支持情况。采用因子分析和回归分析来研究变量之间的关系，并确定更多报告与患者分享治疗决策障碍的预测因素。
首次咨询时信息不足（28.9%）和时间不足（28.4%）是与患者共同做出治疗决策时最常报告的障碍。多变量分析显示，经验不足的医生更常报告系统障碍（P = .00）。患者信任医生并在咨询时有陪同对做出治疗决策最有帮助。提供有关治疗方案的书面信息、再次预约以做出决定、鼓励患者与家庭医生和治疗团队交谈，以及咨询时有第三方在场，这些都被认为有助于鼓励患者参与和思考治疗决策。
肿瘤医生在与患者共同做出治疗决策时遇到困难。需要采取医生支持的干预措施和策略，以增强患者在做出治疗决策过程中的参与度。
