Burton Maria, Collins Karen Anna, Lifford Kate Joanna, Brain Kate, Wyld Lynda, Caldon L, Gath Jacqui, Revell Deirdre, Reed Malcolm William
Sheffield Hallam, University Centre for Health and Social Care Research Montgomery House, Sheffield, South Yorkshire, United Kingdom.
Cardiff University, Institute of Primary Care and Public Health, School of Medicine, Cardiff, United Kingdom.
Psychooncology. 2015 Aug;24(8):878-84. doi: 10.1002/pon.3735. Epub 2014 Dec 22.
Primary Endocrine Therapy (PET) is a good alternative to surgery for breast cancer in older frailer women. Overall survival rates are equivalent although rates of local control are inferior. There is little research regarding the decision support needs of older patients faced with this choice. This qualitative study aimed to explore these among older breast cancer patients offered a choice of treatment, as the basis to develop an appropriate decision support tool.
Semi-structured interviews were undertaken with older women (>75 years) with breast cancer who had been offered a choice of PET or surgery at diagnosis. Women's involvement in their treatment decision and support for the process were explored and analysed using framework analysis.
Thirty-three interviews were undertaken (median age 82, range 75-95 years, 22 PET, 11 surgery). Most women, regardless of treatment choice, wanted tailored information about the different treatment options, their impact on independence, the practicalities of treatment and the risk of recurrence and spread. Surgery was the treatment of choice in women wanting optimal disease control; those choosing PET felt that they were 'too old' for surgery and wanted minimal disruption.
Older women described making active treatment decisions. However, some knowledge was inaccurate. Women wanted information and decision support from their clinicians along with a specific tailored information booklet to support this process.
对于身体较为虚弱的老年女性乳腺癌患者，原发性内分泌治疗（PET）是一种优于手术的良好替代方案。尽管局部控制率较低，但总体生存率相当。关于面临这种选择的老年患者的决策支持需求，研究甚少。这项定性研究旨在探讨那些可选择治疗方案的老年乳腺癌患者的此类需求，以此作为开发合适决策支持工具的基础。
对确诊时可选择PET或手术的老年乳腺癌女性（年龄>75岁）进行半结构式访谈。采用框架分析法对女性参与治疗决策的情况及其对该过程的支持情况进行探索和分析。
共进行了33次访谈（中位年龄82岁，范围75 - 95岁，22例选择PET，11例选择手术）。大多数女性，无论治疗选择如何，都希望获得有关不同治疗方案的量身定制信息，包括这些方案对独立性的影响、治疗的实际情况以及复发和扩散风险。希望实现最佳疾病控制的女性选择手术；选择PET的女性觉得自己“年龄太大”不适合手术，希望干扰最小。
老年女性描述了她们做出积极的治疗决策。然而，一些知识并不准确。女性希望从临床医生那里获得信息和决策支持，并希望有一本专门定制的信息手册来辅助这一过程。
