CTCA at Midwestern Regional Medical Center, Zion, Illinois 60099, USA.
Oncologist. 2012;17(5):607-12. doi: 10.1634/theoncologist.2011-0468. Epub 2012 Apr 24.
Although breast cancer is a highly treatable disease, some women reject conventional treatment opting for unproven "alternative therapy" that may contribute to poor health outcomes. This study sought to understand why some women make this decision and to identify messages that might lead to greater acceptance of evidence-based treatment.
This study explored treatment decision making through in-depth interviews with 60 breast cancer patients identified by their treating oncologists. Thirty refused some or all conventional treatment, opting for alternative therapies, whereas 30 accepted both conventional and alternative treatments. All completed the Beck Anxiety Inventory and the Rotter Locus of Control scale.
Negative first experiences with "uncaring, insensitive, and unnecessarily harsh" oncologists, fear of side effects, and belief in the efficacy of alternative therapies were key factors in the decision to reject potentially life-prolonging conventional therapy. Refusers differed from controls in their perceptions of the value of conventional treatment, believing that chemotherapy and radiotherapy were riskier (p < .0073) and less beneficial (p < .0001) than did controls. Controls perceived alternative medicine alone as riskier than did refusers because its value for treating cancer is unproven (p < .0001). Refusers believed they could heal themselves naturally from cancer with simple holistic methods like raw fruits, vegetables, and supplements.
According to interviewees, a compassionate approach to cancer care plus physicians who acknowledge their fears, communicate hope, educate them about their options, and allow them time to come to terms with their diagnosis before starting treatment might have led them to better treatment choices.
尽管乳腺癌是一种高度可治疗的疾病,但有些女性拒绝接受传统治疗,而选择未经证实的“替代疗法”,这可能导致不良的健康结果。本研究旨在了解为什么有些女性会做出这样的决定,并确定可能导致更多人接受基于证据的治疗的信息。
本研究通过对 60 名乳腺癌患者的深入访谈来探讨治疗决策,这些患者是由他们的肿瘤学家确定的。其中 30 人拒绝了一些或全部传统治疗方法,选择了替代疗法,而 30 人则接受了传统和替代治疗方法。所有患者均完成贝克焦虑量表和罗特控制点量表的评估。
对“冷漠、麻木不仁、过于苛刻”的肿瘤学家的初次负面体验、对副作用的恐惧,以及对替代疗法疗效的信任,是拒绝接受潜在延长生命的传统治疗的关键因素。与对照组相比,拒绝者对传统治疗的价值有不同的看法,他们认为化疗和放疗的风险更高(p<0.0073),益处更小(p<0.0001)。对照组认为单独使用替代疗法的风险比拒绝者高,因为其治疗癌症的价值未经证实(p<0.0001)。拒绝者认为他们可以通过简单的整体疗法,如生的水果、蔬菜和补充剂,从癌症中自然康复。
根据受访者的说法,癌症护理的富有同情心的方法,加上承认患者恐惧、传递希望、向他们传达有关选择的信息,并在开始治疗前给他们时间接受诊断,可能会导致他们做出更好的治疗选择。