Feldman-Stewart Deb, Brundage Michael D, Tong Christine
Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada.
Can J Urol. 2011 Dec;18(6):5998-6006.
We conducted a systematic review of primary evidence to clarify what information influences treatment selection by patients with early stage prostate cancer.
We conducted a systematic review of the Web of Knowledge, using the ALL DATABASES option. Papers were then triaged out on the basis of the title and/or abstract, leaving 120 papers. Reviewing the full papers resulted in a final corpus of 21 papers.
The data suggest that patients typically balance potential benefits against potential side effects but in a complex way with large variation across patients. For some patients, potential benefits relate to chances of survival but, for others, relate to control over cancer spread. The most common potential harm is effect on bladder functioning but even that is not a concern of all patients. Similarly, potential impact on bowel and on sexual functioning affects some patients' decisions but not others. Patient decisions are also affected by information not typically identified as affecting this decision. These include aspects of treatment and decision processes, competencies, and others' opinions, again, with wide variation across patients. The patient's view of which information items affect his decision may also change over time, consistent with a dynamic decision-making process.
Decision support interventions are needed to optimally tailor information for decision-making to the individual patient, and should be designed to accommodate the illustrated variation in patients' needs.
我们对主要证据进行了系统综述，以阐明哪些信息会影响早期前列腺癌患者的治疗选择。
我们使用“所有数据库”选项对《科学网》进行了系统综述。然后根据标题和/或摘要对论文进行筛选，留下120篇论文。对全文进行评审后，最终形成了21篇论文的语料库。
数据表明，患者通常会权衡潜在益处与潜在副作用，但方式复杂，患者之间差异很大。对一些患者来说，潜在益处与生存机会有关，但对另一些患者来说，则与控制癌症扩散有关。最常见的潜在危害是对膀胱功能的影响，但即便如此，也并非所有患者都担心这一点。同样，对肠道和性功能的潜在影响会影响一些患者的决策，但不会影响其他患者。患者的决策还会受到通常未被视为影响该决策的信息的影响。这些信息包括治疗和决策过程的各个方面、能力以及他人的意见，同样，患者之间差异很大。患者对哪些信息项会影响其决策的看法也可能随时间而改变，这与动态决策过程是一致的。
需要决策支持干预措施，以便为个体患者优化决策所需的信息，并应设计这些措施以适应患者需求中所显示的差异。
