Orgerie Marie-Brigitte, Duchange Nathalie, Pélicier Nicole, Rosset Philippe, Lemarié Etienne, Dorval Etienne, Chapet Sophie, Hervé Christian, Moutel Grégoire
CHRU Tours, hôpital Bretonneau, pôle Henry-S.-Kaplan de cancérologie, 37044 Tours cedex, France.
Presse Med. 2012 Mar;41(3 Pt 1):e87-94. doi: 10.1016/j.lpm.2011.07.026. Epub 2011 Nov 12.
The setting of multidisciplinary meeting (MDM) by the French Cancer Plan has introduced new decisional elements in the patient-physician relationship in oncology.
To assess the potential impact of MDM on this relationship, a study was conducted at the Tours Hospital: 145 questionnaires were collected from patients whose files have been discussed in MDM, 40 questionnaires were collected from physicians attending these meetings and an analysis of 324 files was performed.
Patients recognize the decisional process of MDM as reassuring for 80% of them. However, a majority (73%) expressed that the most important for them is the relationship with the referring physician, almost all (96%) having a total or great confidence in him. The results emphasize that trust appears to be related to the quality of communication, open dialogue and the competence of the doctor in particular in the choice of treatment. A review of files shows that in 91% of cases, the opinion of the RCP is applied and that, in 69% of cases, the referring doctor delivers the information to the patient after MDM. From the physicians' perspective, 33/40 report that the MDM do not alter their relationship with the patient. We note that 35/40 express that the consultation after MDM facilitates the presentation of the decision and 37/40 that the decision is always or often applied in accordance with the opinion of the MDM.
MDM appears in most cases in this study not to modify the patient-physician relationship. Due to the patient confidence into the referring physician, the role of this one is essential in integrating the decisional multidisciplinary opinion of MDM and it is important to ensure from his/her disengagement in the decisional process.
法国癌症计划所设定的多学科会议（MDM）在肿瘤学领域的医患关系中引入了新的决策要素。
为评估多学科会议对这种关系的潜在影响，在图尔医院开展了一项研究：从多学科会议上讨论过病历的患者中收集了145份问卷，从参加这些会议的医生中收集了40份问卷，并对324份病历进行了分析。
80%的患者认为多学科会议的决策过程让人安心。然而，大多数患者（73%）表示，对他们来说最重要的是与转诊医生的关系，几乎所有患者（96%）对转诊医生完全信任或高度信任。结果强调，信任似乎与沟通质量、开放对话以及医生在治疗选择方面的能力有关。对病历的审查表明，在91%的病例中，参考委员会（RCP）的意见得到了采纳，在69%的病例中，转诊医生在多学科会议后将信息告知患者。从医生的角度来看，33/40的医生报告称多学科会议并未改变他们与患者的关系。我们注意到，35/40的医生表示多学科会议后的会诊有助于做出决策，37/40的医生表示决策总是或经常按照多学科会议的意见执行。
在本研究的大多数病例中，多学科会议似乎并未改变医患关系。由于患者对转诊医生的信任，转诊医生在整合多学科会议的决策意见方面起着至关重要的作用，并且确保其在决策过程中不参与是很重要的。
