Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Int J Radiat Oncol Biol Phys. 2012 Sep 1;84(1):30-8. doi: 10.1016/j.ijrobp.2011.11.028. Epub 2012 Feb 11.
PURPOSE: To develop a patient decision aid (PtDA) for older women with Stage I, pathologically node negative, estrogen receptor-positive progesterone receptor-positive breast cancer who are considering adjuvant radiotherapy after lumpectomy and to examine its impact on patients' decision making. METHODS AND MATERIALS: A PtDA was developed and evaluated in three steps according to the Ottawa Decision Support Framework: (1) needs assessment (n = 16); (2) Pilot I to examine PtDA acceptability (n = 12); and (3) Pilot II, a pretest posttest (n = 38) with older women with estrogen receptor-positive progesterone receptor-positive breast cancer after lumpectomy who were receiving adjuvant radiation therapy. Measures included patients' satisfaction with the PtDA, self-reported decisional conflict, level of distress, treatment-related knowledge, and choice predisposition. RESULTS: The PtDA is a booklet that details each adjuvant treatment option's benefits, risks, and side effects tailored to the patient's clinical profile; includes a values clarification exercise; and includes steps to guide patients towards their decision. On the basis of qualitative comments and satisfaction ratings, all women thought that the PtDA was helpful and informative. In comparison with their baseline scores, patients had a statistically significant (p < 0.05) reduction in decisional conflict (adjusted mean difference [AMD], -7.18; 95% confidence interval [CI], -13.50 to 12.59); increased clarity of the benefits and risks (AMD, -10.86; CI, -20.33 to 21.49); and improved general treatment knowledge (AMD, 8.99; CI, 2.88-10.28) after using the PtDA. General trends were also reported in the patients' choice predisposition scores that suggested potential differences in treatment decision after PtDA use. CONCLUSIONS: This study provides evidence that this PtDA may be a helpful educational tool for this group of women. The quality of care for older breast cancer patients may be enhanced by the use of a tailored PtDA to help patients be better informed about their treatment options.
目的：为考虑在保乳手术后接受辅助放疗的 I 期、病理淋巴结阴性、雌激素受体阳性孕激素受体阳性乳腺癌的老年女性开发一种患者决策辅助工具（PtDA），并检验其对患者决策的影响。
方法与材料：根据渥太华决策支持框架，分三步开发和评估 PtDA：（1）需求评估（n=16）；（2）初步试验 I 以检验 PtDA 的可接受性（n=12）；以及（3）初步试验 II，对接受保乳术后辅助放疗的雌激素受体阳性孕激素受体阳性乳腺癌老年女性进行前后测试（n=38）。评估指标包括患者对 PtDA 的满意度、自我报告的决策冲突、痛苦程度、治疗相关知识和选择倾向。
结果：PtDA 是一本小册子，详细说明了每种辅助治疗方案的益处、风险和副作用，根据患者的临床特征量身定制；包括价值观澄清练习；并包括指导患者做出决策的步骤。根据定性意见和满意度评分，所有女性都认为 PtDA 很有帮助和信息丰富。与基线评分相比，患者的决策冲突显著降低（调整平均差异[AMD]，-7.18；95%置信区间[CI]，-13.50 至 12.59）；对益处和风险的认识更加清晰（AMD，-10.86；CI，-20.33 至 21.49）；使用 PtDA 后，一般治疗知识得到提高（AMD，8.99；CI，2.88 至 10.28）。患者选择倾向评分也报告了一般趋势，表明使用 PtDA 后治疗决策可能存在差异。
结论：本研究表明，该 PtDA 可能是该类女性的有用教育工具。使用量身定制的 PtDA 帮助患者更好地了解其治疗选择，可能会提高老年乳腺癌患者的护理质量。
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