肿瘤学家对辅助治疗!模型用于风险沟通的应用：一项检验患者对10年预后了解情况的试点研究。
Oncologist use of the Adjuvant! model for risk communication: a pilot study examining patient knowledge of 10-year prognosis.
作者信息
Belkora Jeffrey K, Rugo Hope S, Moore Dan H, Hutton David W, Chen Daniel F, Esserman Laura J
机构信息
Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
出版信息
BMC Cancer. 2009 Apr 28;9:127. doi: 10.1186/1471-2407-9-127.
BACKGROUND
Our purpose was to collect preliminary data on newly diagnosed breast cancer patient knowledge of prognosis before and after oncology visits. Many oncologists use a validated prognostic software model, Adjuvant!, to estimate 10-year recurrence and mortality outcomes for breast cancer local and adjuvant therapy. Some oncologists are printing Adjuvant! screens to use as visual aids during consultations. No study has reported how such use of Adjuvant! printouts affects patient knowledge of prognosis. We hypothesized that Adjuvant! printouts would be associated with significant changes in the proportion of patients with accurate understanding of local therapy prognosis.
METHODS
We recruited a convenience sample of 20 patients seen by 2 senior oncologists using Adjuvant! printouts of recurrence and mortality screens in our academic medical center. We asked patients for their estimates of local therapy recurrence and mortality risks and counted the number of patients whose estimates were within +/- 5% of Adjuvant! before and after the oncology visit, testing whether pre/post changes were significant using McNemar's two-sided test at a significance level of 5%.
RESULTS
Two patients (10%) accurately estimated local therapy recurrence and mortality risks before the oncology visit, while seven out of twenty (35%) were accurate afterwards (p = 0.125).
CONCLUSION
A majority of patients in our sample were inaccurate in estimating their local therapy recurrence and mortality risks, even after being shown printouts summarizing these risks during their oncology visits. Larger studies are needed to replicate or repudiate these preliminary findings, and test alternative methods of presenting risk estimates. Meanwhile, oncologists should be wary of relying exclusively on Adjuvant! printouts to communicate local therapy recurrence and mortality estimates to patients, as they may leave a majority of patients misinformed.
背景
我们的目的是收集关于新诊断乳腺癌患者在肿瘤学就诊前后对预后知识了解情况的初步数据。许多肿瘤学家使用经过验证的预后软件模型“辅助！”来估计乳腺癌局部及辅助治疗的10年复发率和死亡率结果。一些肿瘤学家会打印“辅助！”的界面用作会诊时的视觉辅助工具。尚无研究报告这种使用“辅助！”打印件的方式如何影响患者对预后的了解。我们假设“辅助！”打印件会与准确理解局部治疗预后的患者比例的显著变化相关。
方法
我们在学术医疗中心招募了一个便利样本，包括20名由2位资深肿瘤学家诊治的患者，这些肿瘤学家使用了“辅助！”的复发率和死亡率界面打印件。我们询问患者对局部治疗复发和死亡风险的估计，并统计估计值在“辅助！”估计值正负5%范围内的患者数量，在肿瘤学就诊前后进行统计，使用麦克尼马尔双侧检验在5%的显著性水平下检验前后变化是否显著。
结果
两名患者（10%）在肿瘤学就诊前准确估计了局部治疗复发和死亡风险，而20名患者中有7名（35%）在就诊后估计准确（p = 0.125）。
结论
在我们的样本中，大多数患者在估计其局部治疗复发和死亡风险时不准确，即使在肿瘤学就诊期间向他们展示了总结这些风险的打印件之后。需要更大规模的研究来重复或反驳这些初步发现，并测试呈现风险估计的替代方法。同时，肿瘤学家应谨慎，不要仅仅依赖“辅助！”打印件向患者传达局部治疗复发和死亡估计，因为这可能会使大多数患者得到错误信息。
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