患者-医生对临床试验讨论的跨文化回忆达成一致。
Patient-doctor agreement on recall of clinical trial discussion across cultures.
机构信息
IBCSG Coordinating Center, Bern; Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland.
IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, USA.
出版信息
Ann Oncol. 2013 Feb;24(2):391-397. doi: 10.1093/annonc/mds288. Epub 2012 Sep 27.
BACKGROUND
The purpose was to investigate patient-doctor agreement on clinical trial discussion cross-culturally.
METHODS
In the International Breast Cancer Study Group Trial 33-03 on shared decision-making for early breast cancer in Australian/New Zealand (ANZ) and Swiss/German/Austrian (SGA) centers, doctor and patient characteristics plus doctor stress and burnout were assessed. Within 2 weeks post-consultation about treatment options, the doctor and patient reported independently, whether a trial was discussed. Odds ratios of agreement for covariables were estimated by generalized estimating equations for each language cohort, with doctor as a random effect.
RESULTS
In ANZ, 21 doctors and 339 patients were eligible; in SGA, 41 doctors and 427 patients. In cases where the doctor indicated 'no trial discussed', 82% of both ANZ and SGA patients agreed; if the doctor indicated 'trial discussed', 50% of ANZ and 38% of SGA patients agreed, respectively. Factors associated with higher agreement were: low tumor grade and fewer patients recruited into clinical trials in SGA; public institution, patient born in ANZ (versus other), higher doctor depersonalization and personal accomplishment in ANZ.
CONCLUSION
There is discordance between oncologists and their patients regarding clinical trial discussion, particularly when the doctor indicates that a trial was discussed. Factors contributing to this agreement vary by culture.
背景
本研究旨在调查跨文化背景下医患双方在临床试验讨论方面的一致性。
方法
在针对澳大利亚/新西兰（ANZ）和瑞士/德国/奥地利（SGA）中心早期乳腺癌患者的国际乳腺癌研究小组 33-03 试验中，评估了医生和患者的特征以及医生的压力和倦怠情况。在咨询治疗方案后 2 周内，医生和患者分别独立报告是否讨论了临床试验。使用广义估计方程对每个语言队列中的协变量进行了一致性的优势比估计，其中医生作为随机效应。
结果
在 ANZ 中，有 21 名医生和 339 名患者符合条件；在 SGA 中，有 41 名医生和 427 名患者符合条件。在医生表示“未讨论临床试验”的情况下，82%的 ANZ 和 SGA 患者表示同意；如果医生表示“讨论了临床试验”，则 ANZ 患者中有 50%表示同意，而 SGA 患者中则有 38%表示同意。与更高的一致性相关的因素包括：肿瘤分级较低，SGA 中招募的患者较少；公共机构，患者在 ANZ 出生（而非其他地方），ANZ 中医生的去人性化和个人成就感较高。
结论
在临床试验讨论方面，肿瘤医生与其患者之间存在不一致性，特别是当医生表示讨论了临床试验时。导致这种一致性的因素因文化而异。
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