Tariman Joseph D, Berry Donna L, Cochrane Barbara, Doorenbos Ardith, Schepp Karen G
Myeloma Program, Northwestern University, Chicago, IL, USA.
Oncol Nurs Forum. 2012 Jan;39(1):E70-83. doi: 10.1188/12.ONF.E70-E83.
PURPOSE/OBJECTIVES: To review physician, patient, and contextual factors that affect treatment decision making in older adults diagnosed with cancer, and to relate those factors to theoretical models of decision making.
PubMed (1966 to April 2010), PsycINFO (1967 to April 2010) and CINAHL® (1982 to April 2010) databases were searched to access relevant medical, psychological, and nursing literature.
Physician factors in treatment decisions included physician's personal beliefs and values, medical expertise, practice type, perception of lowered life expectancy, medical factors, power, and communication style. Patient factors included personal beliefs and values, ethnicity, decisional control preferences, previous health-related experience, perception of the decision-making process, and personal factors. Contextual factors included availability of caregiver, insurance, financial status, and geographical barrier.
A diverse group of factors were identified, which are likely to form a unique framework to understand clinical decision making and plan future investigations in older adult patient populations. Using longitudinal and prospective designs to examine the real-time interplay of patient, physician, and contextual factors will enable a better understanding of how those divergent factors influence actual treatment decisions.
Oncology nurses can advocate autonomous (patient-driven), shared, or family-controlled treatment decisions, depending on an older patient's decisional role preference. Nurses can support patient autonomy during treatment decision making by coaching patients to engage in discussion of various evidence-based treatment options and a comprehensive discussion of the probability of success for each option with specialist providers. Oncology nurses may be able to promote treatment decisions that are consistent with a patient's personal preferences and values, with strong consideration of the patient's personal contexts.
目的/目标：回顾影响老年癌症患者治疗决策的医生、患者及背景因素，并将这些因素与决策理论模型相关联。
检索了PubMed（1966年至2010年4月）、PsycINFO（1967年至2010年4月）和CINAHL®（1982年至2010年4月）数据库，以获取相关医学、心理学和护理学文献。
治疗决策中的医生因素包括医生的个人信念和价值观、医学专业知识、执业类型、对预期寿命降低的认知、医学因素、权力及沟通方式。患者因素包括个人信念和价值观、种族、决策控制偏好、以往与健康相关的经历、对决策过程的认知以及个人因素。背景因素包括护理人员的可获得性、保险、财务状况和地理障碍。
确定了多种因素，这些因素可能构成一个独特的框架，以理解临床决策并规划对老年患者群体的未来研究。采用纵向和前瞻性设计来研究患者、医生和背景因素的实时相互作用，将有助于更好地理解这些不同因素如何影响实际治疗决策。
肿瘤护士可以根据老年患者的决策角色偏好，倡导自主（患者驱动）、共同或家庭控制的治疗决策。护士可以在治疗决策过程中支持患者的自主权，指导患者与专科医生讨论各种基于证据的治疗方案，并全面讨论每种方案成功的可能性。肿瘤护士或许能够促进符合患者个人偏好和价值观的治疗决策，同时充分考虑患者的个人背景。
