Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA 22908, USA.
J Clin Oncol. 2010 Jun 20;28(18):3090-5. doi: 10.1200/JCO.2009.27.8077. Epub 2010 May 10.
Women at high risk of breast cancer face the complex decision of whether to take tamoxifen or raloxifene for breast cancer chemoprevention. We investigated what is known about decisions of women regarding chemoprevention.
Using MEDLINE, CINAHL, and PSYCINFO, plus reviewing reference lists of relevant articles, in December 2009 we identified 13 studies that addressed patient decisions about breast cancer chemoprevention, were published in 1995 or later, were peer-reviewed primary clinical studies, and reported rates at which participants showed interest in (hypothetical uptake) or accepted (real uptake) chemoprevention medications.
Nine studies provided information about hypothetical breast cancer chemoprevention decisions (mean uptake rate, 24.7%) and five provided information about real decisions (mean uptake rate, 14.8%). The range of rates was wide, and each of the hypothetical uptake studies assessed interest differently. A logistic regression model found significant correlation with uptake of decision type (hypothetical versus real, odds ratio [OR] = 1.65; 95% CI, 1.26 to 2.16), educational or decision support intervention (provided v not, OR = 0.21; 95% CI, 0.17 to 0.27), and cohort risk for breast cancer (high-risk v general population, OR = 0.65; 95% CI, 0.56 to 0.75). Perceived vulnerability to breast cancer was consistently correlated with increased uptake, and concern for adverse effects was correlated with reduced uptake. All studies used a correlational/descriptive design, and most studies used convenience sampling strategies.
Breast cancer chemoprevention uptake rates are low and variation is wide. Hypothetical uptake rates are higher than real uptake, and interventions markedly reduce uptake. Research is needed that uses reproducible sampling methods and examines decision support strategies that lead to quality decisions.
患有乳腺癌高危风险的女性面临着是否选择他莫昔芬或雷洛昔芬进行乳腺癌化学预防的复杂决策。我们研究了女性在化学预防方面的决策。
我们使用 MEDLINE、CINAHL 和 PSYCINFO，并审查相关文章的参考文献列表，于 2009 年 12 月确定了 13 项研究，这些研究涉及患者对乳腺癌化学预防的决策，发表于 1995 年或之后，为同行评议的主要临床研究，并报告了参与者对化学预防药物表现出兴趣（假设采用率）或接受（实际采用率）的比例。
9 项研究提供了关于假设性乳腺癌化学预防决策的信息（假设采用率的平均值为 24.7%），5 项研究提供了关于实际决策的信息（实际采用率的平均值为 14.8%）。采用率的范围很广，每个假设性采用率研究都以不同的方式评估了兴趣。逻辑回归模型发现，决策类型（假设性与实际性，优势比 [OR] = 1.65；95%置信区间，1.26 至 2.16）、教育或决策支持干预（提供与不提供，OR = 0.21；95%置信区间，0.17 至 0.27）以及乳腺癌风险（高危人群与普通人群，OR = 0.65；95%置信区间，0.56 至 0.75）之间存在显著相关性。对乳腺癌的感知易感性与采用率的增加相关，对不良反应的关注与采用率的降低相关。所有研究均采用相关性/描述性设计，且大多数研究采用便利抽样策略。
乳腺癌化学预防的采用率较低，且差异较大。假设采用率高于实际采用率，干预措施明显降低了采用率。需要开展使用可复制的抽样方法并检验导致高质量决策的决策支持策略的研究。
