University of California San Francisco, USA.
J Natl Compr Canc Netw. 2011 Jul 1;9(7):707-12. doi: 10.6004/jnccn.2011.0061.
Adjuvant! is a model that provides recurrence and mortality risk predictions for patients with breast cancer considering adjuvant therapies. Although low-risk patients who saw Adjuvant! chose adjuvant therapy less frequently, whether this was because of educational or other aspects of the decision aid is unknown. The authors explored whether Adjuvant! affects choice of therapy through increased patient knowledge. A subset of data were analyzed from a cluster randomized trial in which oncology practices in 2 major United States cities were randomly assigned to use either Adjuvant! or an informational pamphlet to educate patients. Of 405 patients, 48 were low-risk, with 28 assigned to the decision aid and 20 to the pamphlet. Among the low-risk patients, using frequency tables and Fisher exact tests, the authors explored whether Adjuvant! was associated with more accurate patient estimates of survival; whether accuracy was associated with treatment choice; and whether, after controlling for accuracy, any remaining association was seen between Adjuvant! and treatment choice. Adjuvant! was associated with more accurate estimates of baseline prognosis compared with the pamphlet (57% vs. 25%; P = .04). Patients who had more accurate estimates of baseline prognosis were less likely to choose adjuvant therapy (62% vs. 89%; P = .04). After controlling for accuracy, no statistically significant association was found between the use of Adjuvant! and adjuvant therapy (P = .59 and P = .11 for inaccurate and accurate patients, respectively). Adjuvant! seems to influence patient choice through educational rather than other means of persuasion. However, many patients held inaccurate risk perceptions after viewing Adjuvant!.
辅助！是一个模型，提供了乳腺癌患者的复发和死亡率风险预测，考虑到辅助治疗。尽管看到辅助！的低风险患者选择辅助治疗的频率较低，但这是由于教育还是决策辅助工具的其他方面尚不清楚。作者探讨了辅助！是否通过增加患者的知识来影响治疗选择。从一项在美国两个主要城市的肿瘤学实践中进行的集群随机试验中分析了部分数据，这些实践被随机分配使用辅助！或信息手册来教育患者。在 405 名患者中，有 48 名是低风险患者，其中 28 名患者被分配使用决策辅助工具，20 名患者使用小册子。在低风险患者中，作者使用频数表和 Fisher 确切检验，探讨了辅助！是否与患者对生存的更准确估计有关；准确性是否与治疗选择有关；以及在控制准确性后，辅助！与治疗选择之间是否存在任何剩余关联。与小册子相比，辅助！与更准确的基线预后估计相关（57%对 25%；P =.04）。对基线预后估计更准确的患者不太可能选择辅助治疗（62%对 89%；P =.04）。在控制准确性后，辅助！的使用与辅助治疗之间没有统计学上显著的关联（不准确和准确患者的 P 值分别为.59 和.11）。辅助！似乎通过教育而不是其他说服手段影响患者的选择。然而，许多患者在观看辅助！后仍然存在不准确的风险感知。
