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听神经瘤的观察和随访失败。

Acoustic tumor observation and failure to follow-up.

机构信息

Pittsburgh Ear Associates, Pittsburgh, PA 15090, USA.

出版信息

Otolaryngol Head Neck Surg. 2010 Mar;142(3):400-4. doi: 10.1016/j.otohns.2009.10.047. Epub 2010 Jan 8.

Abstract

OBJECTIVE

To review the clinical course of patients undergoing observation for their acoustic tumor with evaluation of the incidence and contributing variables to failure to follow-up.

STUDY DESIGN

Case series with chart review and telephone interview.

SETTING

Single subspecialty practice.

SUBJECTS AND METHODS

One hundred twenty-two patients underwent an observation period after their unilateral acoustic tumor was diagnosed. Follow-up patterns were noted and multiple patient variables were analyzed to determine risk factors that contributed to risk of failing to keep prescribed follow-up. Telephone interviews and/or public record reviews were conducted to determine the reasons for failing to follow-up.

RESULTS

Fifty-two (42.6%) patients failed to keep prescribed follow-up. No preoperative patient or tumor variables were correlated with the risk of failure to follow-up. The investigators were able to contact and interview 20 patients to determine reasons for not keeping follow-up. Of these patients, nine (45%) electively chose not to follow-up, six (30%) did not appear to have a clear understanding of their diagnosis or treatment options despite adequate counseling, and five (25%) had medical problems that took precedence over the acoustic tumor. Very few patients elected to reschedule follow-up even after contact was made.

CONCLUSION

Failure to follow-up is a serious problem with acoustic tumor observation protocols. It is difficult to detect which patients are at risk for noncompliance. Patient noncompliance with observation protocols should be considered when determining the most appropriate treatment for each acoustic tumor patient.

摘要

目的

回顾接受观察的听神经瘤患者的临床过程,评估未进行随访的发生率和相关因素。

研究设计

病例系列,图表回顾和电话访谈。

设置

单专科实践。

受试者和方法

122 例单侧听神经瘤患者在诊断后接受了观察期。记录随访模式,并分析多个患者变量,以确定导致未能按规定进行随访的风险因素。通过电话访谈和/或公共记录审查,确定未能随访的原因。

结果

52 例(42.6%)患者未能按规定进行随访。术前患者或肿瘤变量与随访失败的风险无关。研究人员能够联系并访谈 20 例患者,以确定未随访的原因。在这些患者中,有 9 例(45%)是出于自愿选择不进行随访,6 例(30%)尽管进行了充分的咨询,但对诊断或治疗方案似乎没有明确的了解,5 例(25%)有医疗问题,优先于听神经瘤。即使联系上了,也只有极少数患者选择重新安排随访。

结论

未能随访是听神经瘤观察方案中的一个严重问题。很难发现哪些患者有不遵守规定的风险。在为每位听神经瘤患者确定最合适的治疗方案时,应考虑患者对观察方案的不依从性。

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