Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
Dis Colon Rectum. 2012 Sep;55(9):970-5. doi: 10.1097/DCR.0b013e31825f2479.
Previous research in colorectal cancer has focused on survival, recurrence, and functional outcomes. Few have assessed the decisional needs of patients or the information patients are retaining from the informed consent process.
The aims of this study were to describe the decisional needs of adult patients with rectal cancer when deciding on the surgical treatment of their disease and to identify gaps in patients' recollection of the informed consent discussion.
Face-to-face interviews were conducted with the use of a questionnaire based on the validated Ottawa Decision Support Framework Needs Assessment.
This study was performed at a university-based academic Cancer Assessment Center, in Ottawa, Ontario, Canada.
Adult patients with rectal cancer treated with low anterior resection or abdominoperineal resection were included.
The primary outcomes measured were patients' knowledge and understanding of decision and their decisional needs.
Thirty patients were interviewed between November 2009 and July 2010. Eighty percent were male, with a median age of 65. None of the patients perceived having a choice of surgical options. When questioned about the main outcomes of rectal cancer surgery, 47% could not recall a preoperative discussion of risks to bowel function, 47% could not recall a preoperative discussion of risks to sexual function, and 57% could not recall a preoperative discussion of risks to urinary function. Patients would like information regarding functional outcomes, body image, and the immediate postoperative period. A minority of patients desire information regarding cure rate, need for a second surgery, or the ability of surgery to treat their symptoms. Patients would like information that is portable and trusted by their health care team that they can review at their own time.
To avoid introducing decisional conflict before surgery, patients were interviewed at the first postoperative visit. Preoperative informed consent discussions were not standardized.
Despite a comprehensive educational oncology pathway, patients retain little of the informed consent discussion. This study highlights the dichotomy between the outcomes that surgeons and patients value most. The results of this study will guide future efforts to improve informed consent.
先前关于结直肠癌的研究主要集中在生存、复发和功能结果方面。很少有研究评估患者的决策需求或患者从知情同意过程中保留的信息。
本研究旨在描述直肠癌症患者在决定其疾病的手术治疗时的决策需求，并确定患者对知情同意讨论回忆的差距。
面对面访谈使用基于经过验证的渥太华决策支持框架需求评估的问卷进行。
本研究在加拿大安大略省渥太华的一所大学癌症评估中心进行。
接受低位前切除术或腹会阴切除术治疗的直肠癌症成年患者。
主要观察指标是患者对决策的知识和理解及其决策需求。
2009 年 11 月至 2010 年 7 月期间对 30 名患者进行了访谈。80%为男性，中位年龄为 65 岁。没有患者认为有选择手术方案的余地。当被问及直肠癌症手术的主要结果时，47%的患者无法回忆起术前关于肠道功能风险的讨论，47%的患者无法回忆起术前关于性功能风险的讨论，57%的患者无法回忆起术前关于尿功能风险的讨论。患者希望了解有关功能结果、身体形象和术后即刻期的信息。少数患者希望了解有关治愈率、需要第二次手术或手术能否治疗其症状的信息。患者希望获得他们的医疗团队信任并可自行查看的便携信息。
为了避免在手术前引入决策冲突，患者在术后首次就诊时接受了访谈。术前知情同意讨论没有标准化。
尽管有全面的肿瘤学教育途径，但患者对知情同意讨论的记忆很少。本研究强调了外科医生和患者最重视的结果之间的二分法。本研究的结果将指导未来改善知情同意的努力。
