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[老年前列腺癌患者:患者信息与共同决策]

[Elderly prostate cancer patients: patient information and shared decision making].

作者信息

Ernstmann N, Jaeger J, Kowalski C, Pfaff H, Weißbach L

机构信息

Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Universität zu Köln (IMVR), Eupener Straße 129, 50933 Köln, Deutschland.

出版信息

Urologe A. 2013 Jun;52(6):847-52. doi: 10.1007/s00120-012-3071-7.

Abstract

INTRODUCTION

Some data exist on information and decision-making preferences of elderly prostate cancer patients but little is known about whether communication needs are being met in urological practice. Therefore, it was the aim of this study to examine the information and shared decision-making experiences of prostate cancer patients over 75 years old.

MATERIALS AND METHODS

The HAROW (hormonal therapy, active surveillance, radiation, operation and watchful waiting) study is a prospective, observational study designed to collect clinical data and patient reported outcome of different treatment options for patients newly diagnosed with localized prostate cancer under real conditions. At 6-month intervals general clinical data, PROs (e.g. quality of life, quality of physician-patient interaction) and individual costs are documented. Data from 2,482 patients at 4 time points from T0 (initial diagnosis) to T3 (24 months follow-up) were analyzed.

RESULTS

T-tests and χ(2)-tests revealed no significant differences in terms of shared decision-making and information to different treatment options between patients aged over 75 years old and the rest of the sample. Regarding information on self-help groups, rehabilitation options and a second medical opinion, there were significant differences between prostate cancer patient age groups: patients aged over 75 years old received less information on these aspects at all points in time.

CONCLUSION

Patients at all ages feel activated by urologists and are informed about different treatment options. However, there is room for improvement in terms of informing especially elderly prostate cancer patients about rehabilitation, second medical opinions and self-help groups. Special information tools and decision aids for prostate cancer patients aged over 75 years old should be developed and implemented to meet the specific information needs.

摘要

引言

关于老年前列腺癌患者的信息及决策偏好已有一些数据,但对于泌尿外科实践中患者的沟通需求是否得到满足却知之甚少。因此,本研究旨在调查75岁以上前列腺癌患者的信息及共同决策体验。

材料与方法

HAROW(激素治疗、主动监测、放疗、手术及观察等待)研究是一项前瞻性观察性研究,旨在在实际情况下收集新诊断为局限性前列腺癌患者不同治疗方案的临床数据及患者报告的结局。每隔6个月记录一般临床数据、患者报告结局(如生活质量、医患互动质量)及个人费用。分析了2482例患者从T0(初始诊断)到T3(24个月随访)4个时间点的数据。

结果

t检验和χ²检验显示,75岁以上患者与其余样本在共同决策及不同治疗方案信息方面无显著差异。在自助小组、康复选择及二次医疗意见的信息方面,前列腺癌患者年龄组之间存在显著差异:75岁以上患者在所有时间点获得的这些方面的信息较少。

结论

各年龄段的患者都感到泌尿外科医生积极主动,并了解了不同的治疗方案。然而,在向老年前列腺癌患者提供康复、二次医疗意见及自助小组方面的信息方面仍有改进空间。应开发并实施针对75岁以上前列腺癌患者的特殊信息工具和决策辅助工具,以满足其特定的信息需求。

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