Department of Upper Gastrointestinal Surgery, Royal Preston Hospital, Preston, UK.
Br J Surg. 2011 Aug;98(8):1124-31; discussion 1132. doi: 10.1002/bjs.7537. Epub 2011 Jun 14.
Establishing preferences for surgery is paramount to preoperative patient counselling. This study aimed to prioritize and compare preferences of patients and doctors towards surgery for oesophagogastric cancer, to aid the counselling process.
A discrete-choice questionnaire containing hypothetical scenarios was designed to test patient preferences for six treatment attributes: mortality, morbidity, quality of life (QoL), cure rate, hospital type and surgeon's reputation. The survey was mailed to all patients who underwent oesophagogastric cancer resection from 2008 to 2009 at two teaching hospital sites. All doctors at these sites with previous experience in counselling patients for cancer surgery were also identified and presented with the survey. Results were analysed using a random-effects probit regression model. Spearman correlation was used to compare participants' implicit choices from the discrete-choice scenarios (their true preferences) with their explicit choices from the direct ranking of preferences (their perceived preferences).
Eighty-one patients and 90 doctors completed the survey. Some 15 per cent of patients and 31 per cent of doctors based their choices solely on QoL. In order of importance, patients based their implicit responses on QoL (β = 1.19), cure rate (β = 0.82), morbidity (β = - 0.70), surgeon's reputation (β = 0.60), mortality (β = - 0.57) and hospital type (β = 0.26). Doctors similarly indicated QoL (β = 1.14) and hospital type (β = 0.31) as highest and lowest preferences respectively, but placed far greater emphasis on mortality (β = - 0.80) than morbidity (β = - 0.35). Implicit and explicit preferences correlated only for morbidity and surgeon's reputation in the patient cohort.
Clinicians may better meet patients' expectations and facilitate informed decision-making if QoL, cure rate and morbidity are emphasized foremost. A similar study employing preoperative patients is warranted for further clarification of preferences.
在术前患者咨询中，建立对手术的偏好至关重要。本研究旨在优先考虑并比较患者和医生对胃食管交界癌手术的偏好，以辅助咨询过程。
设计了一份包含假设情景的离散选择问卷，以测试患者对六种治疗属性的偏好：死亡率、发病率、生活质量（QoL）、治愈率、医院类型和外科医生的声誉。该调查邮寄给了 2008 年至 2009 年在两个教学医院接受胃食管交界癌切除术的所有患者。还确定了这两个地点所有有癌症手术咨询经验的医生，并向他们提供了调查。使用随机效应概率回归模型分析结果。使用 Spearman 相关系数比较了参与者从离散选择情景中隐含选择（真实偏好）与从直接偏好排名中明确选择（感知偏好）。
81 名患者和 90 名医生完成了调查。约 15%的患者和 31%的医生仅根据 QoL 做出选择。按重要性顺序，患者根据 QoL（β=1.19）、治愈率（β=0.82）、发病率（β=-0.70）、外科医生的声誉（β=0.60）、死亡率（β=-0.57）和医院类型（β=0.26）做出隐含反应。医生同样将 QoL（β=1.14）和医院类型（β=0.31）作为最高和最低的偏好，但比发病率（β=-0.35）更强调死亡率（β=-0.80）。在患者组中，只有发病率和外科医生的声誉与隐含和显性偏好相关。
如果首先强调 QoL、治愈率和发病率，临床医生可能会更好地满足患者的期望并促进知情决策。有必要进行类似的术前患者研究，以进一步澄清偏好。
