Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
Cancer Treat Rev. 2015 Feb;41(2):197-215. doi: 10.1016/j.ctrv.2014.12.010. Epub 2014 Dec 26.
Cancer is a disease that affects mostly older adults. Older adults often have other chronic health conditions in addition to cancer and may have different health priorities, both of which can impact cancer treatment decision-making. However, no systematic review of factors that influence an older cancer patient's decision to accept or decline cancer treatment has been conducted.
Systematic review of the literature published between inception of the databases and February 2013. Dutch, English, French or German articles reporting on qualitative studies, cross-sectional, longitudinal observational or intervention studies describing factors why older adults accepted or declined cancer treatment examining actual treatment decisions were included. Ten databases were used. Two independent reviewers reviewed manuscripts and performed data abstraction using a standardized form and the quality of studies was assessed with the Mixed Methods Appraisal Tool.
Of 17,343 abstracts reviewed, a total of 38 studies were included. The majority focused on breast and prostate cancer treatment decisions and most studies used a qualitative design. Important factors for accepting treatment were convenience and success rate of treatment, seeing necessity of treatment, trust in the physician and following the physician's recommendation. Factors important for declining cancer treatment included concerns about the discomfort of the treatments, fear of side effects and transportation difficulties.
Although the reasons why older adults with cancer accepted or declined treatment varied considerably, the most consistent determinant was physician recommendation. Further studies using large, representative samples and exploring decision-making incorporating health literacy and comorbidity are needed.
癌症主要影响老年人。老年人除了癌症之外，通常还有其他慢性健康问题，并且可能有不同的健康优先级，这两者都会影响癌症治疗决策。然而，目前还没有对影响老年癌症患者接受或拒绝癌症治疗决定的因素进行系统评价。
对在数据库创建之初至 2013 年 2 月期间发表的文献进行系统评价。纳入报告定性研究、横断面研究、纵向观察性研究或干预性研究的荷兰语、英语、法语或德语文章，这些研究描述了为什么老年人接受或拒绝癌症治疗的因素，研究内容涉及实际的治疗决策。使用了 10 个数据库。两位独立的评审员使用标准化表格审查手稿并进行数据提取，并使用混合方法评估工具评估研究质量。
在对 17343 篇摘要进行审查后，共有 38 项研究被纳入。其中大多数研究聚焦于乳腺癌和前列腺癌的治疗决策，并且大多数研究采用了定性设计。接受治疗的重要因素包括治疗的便利性和成功率、认为治疗有必要、对医生的信任和遵循医生的建议。拒绝癌症治疗的重要因素包括对治疗不适的担忧、对副作用的恐惧以及交通困难。
尽管老年癌症患者接受或拒绝治疗的原因差异很大，但最一致的决定因素是医生的建议。需要使用大型、代表性样本进行进一步研究，以探索将健康素养和合并症纳入决策过程的治疗决策。
