Cassileth B R, Soloway M S, Vogelzang N J, Schellhammer P S, Seidmon E J, Hait H I, Kennealey G T
University of Pennsylvania Cancer Center, Hospital of the University of Pennsylvania, Philadelphia.
Urology. 1989 May;33(5 Suppl):57-62. doi: 10.1016/0090-4295(89)90108-8.
Given the current preference of many patients for an active role in decision-making regarding their care, the feasibility of patients making their own treatment choices was investigated, and the reasons for their selections were studied. Subjects comprised previously untreated Stage D prostate cancer patients for whom hormonal therapy was indicated. Thirteen institutions entered 159 patients into the study. After discussing treatment choices with their physicians, the patients took home a two-page letter explaining two options: surgical castration and therapy with Zoladex (goserelin acetate), a depot luteinizing hormone-releasing hormone (LHRH) analogue injected subcutaneously every twenty-eight days. Patients were encouraged to discuss the treatment choices with their families. After selecting a treatment approach, patients completed a "decision questionnaire" and then treatment was initiated. Of the 147 patients who completed baseline questionnaires, 78 percent selected Zoladex and 22 percent selected orchiectomy. The primary reason for selecting Zoladex included avoidance of surgery (36%), success of treatment (18%), convenience of the drug (10%), and physician's advice (10%). Patients chose surgery primarily because of convenience (32%) and success of treatment (29%). Three months later, patients and their wives completed another questionnaire, which assessed their satisfaction with their treatment choices. Ninety-three percent of patients and 91 percent of patients' wives indicated that they would select the same treatment again.
鉴于当前许多患者倾向于在医疗护理决策中发挥积极作用，研究了患者自行做出治疗选择的可行性，并对他们做出选择的原因进行了研究。研究对象包括之前未接受治疗且适合激素治疗的D期前列腺癌患者。13家机构让159名患者参与了该研究。在与医生讨论治疗选择后，患者们带回家一封两页的信，信中解释了两种选择：手术去势和使用诺雷德（醋酸戈舍瑞林）进行治疗，诺雷德是一种长效促性腺激素释放激素（LHRH）类似物，每28天皮下注射一次。鼓励患者与家人讨论治疗选择。在选择了一种治疗方法后，患者填写一份“决策问卷”，然后开始治疗。在完成基线问卷的147名患者中，78%选择了诺雷德，22%选择了睾丸切除术。选择诺雷德的主要原因包括避免手术（36%）、治疗成功（18%）、药物便利性（10%）和医生建议（10%）。患者选择手术主要是因为便利性（32%）和治疗成功（29%）。三个月后，患者及其妻子填写了另一份问卷，该问卷评估了他们对治疗选择的满意度。93%的患者和91%的患者妻子表示他们会再次选择相同的治疗方法。
