Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
Gynecol Oncol. 2013 Nov;131(2):430-6. doi: 10.1016/j.ygyno.2013.08.017. Epub 2013 Aug 27.
Few available tools facilitate cancer patients and physicians' discussions of quality of life and end-of-life. Our objective was to develop a web-based tool to promote advance care planning for women with ovarian cancer.
Women with ovarian cancer, their families, clinicians and researchers met to identify ways to improve cancer care. A prototype website was created to address advance care planning, focusing on advance healthcare directives (AHD) and palliative care consultation. Patients were recruited from a gynecologic oncology clinic for a pilot randomized controlled trial. Primary outcomes included completion of an AHD and palliative care consultation.
At study completion, 53 women with ovarian cancer were enrolled and 35 completed the study. The mean age at enrollment was 57.9 ± 9.5 years; most were newly diagnosed or at first recurrence. There were no statistical differences in completion of AHD (p=0.220) or palliative care consultation (p=0.440) between intervention and control groups. However, women in the intervention group showed evidence of moving toward decision making regarding AHD and palliative care and lower decisional conflict. Women assigned to the intervention, compared to control website, were highly satisfied with the amount (p=0.054) and quality (p=0.119) of information and when they accessed the website, used it longer (p=0.049). Overall website use was lower than expected, resulting from several patient-related and design barriers.
A website providing information and decisional support for women with ovarian cancer is feasible. Increasing frequency of website use requires future research.
目前可用的工具很少能促进癌症患者和医生讨论生活质量和临终问题。我们的目标是开发一种基于网络的工具，以促进卵巢癌患者的预先护理计划。
卵巢癌患者、其家属、临床医生和研究人员开会确定了改善癌症护理的方法。创建了一个原型网站来解决预先护理计划问题，重点是预先医疗指令（AHD）和姑息治疗咨询。从妇科肿瘤学诊所招募患者参加一项先导随机对照试验。主要结局包括完成 AHD 和姑息治疗咨询。
在研究完成时，招募了 53 名卵巢癌患者，其中 35 名完成了研究。入组时的平均年龄为 57.9 ± 9.5 岁；大多数为新诊断或首次复发。干预组和对照组在完成 AHD（p=0.220）或姑息治疗咨询（p=0.440）方面无统计学差异。然而，干预组的女性在 AHD 和姑息治疗方面表现出决策的迹象，并且决策冲突较低。与对照组网站相比，分配到干预组的女性对信息量（p=0.054）和质量（p=0.119）以及访问网站的时间（p=0.049）非常满意。由于患者相关和设计方面的障碍，网站的整体使用频率低于预期。
为卵巢癌患者提供信息和决策支持的网站是可行的。增加网站的使用频率需要进一步的研究。
