Slatore Christopher G, Au David H, Press Nancy, Wiener Renda Soylemez, Golden Sara E, Ganzini Linda
Health Services Research & Development, Portland VA Medical Center, Portland, OR, USA; Section of Pulmonary & Critical Care Medicine, Portland VA Medical Center, Portland, OR, USA; Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
Health Service Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA; Division of Pulmonary & Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Respir Med. 2015 Apr;109(4):532-9. doi: 10.1016/j.rmed.2015.01.007. Epub 2015 Jan 27.
Among patients undergoing lung cancer evaluation for newly diagnosed, incidental pulmonary nodules, it is important to evaluate the shared power and responsibility domain of patient-centered communication. We explored Veterans' perceptions of decision making with regards to an incidentally-detected pulmonary nodule.
We conducted semi-structured, qualitative interviews of 19 Veterans from one medical center with incidentally-detected pulmonary nodules that were judged as having a low risk for malignancy. We used qualitative description for the analysis, focusing on patients' perceptions of shared decision making with their primary care provider (PCP). Interviews were conducted in 2011 and 2012.
Patients almost always played a passive role in deciding how and when to evaluate their pulmonary nodule for the possibility of malignancy. Some patients felt comfortable with this role, expressing trust that their clinician would provide the appropriate care. Other patients were not satisfied with how these decisions were made with some expressing concern that no decisions had actually occurred. Regardless of how satisfied they were with the decision, patients did not report discussing how they liked to make decisions with their PCP.
Veterans in our study did not engage in shared decision making with their clinician. Some were satisfied with this approach although many would have preferred a shared approach. In order to reduce patient distress and improve satisfaction, clinicians may want to consider adopting a shared approach when making decisions about pulmonary nodule evaluation.
在对新诊断的偶然发现的肺结节进行肺癌评估的患者中，评估以患者为中心的沟通中共同的权力和责任范围很重要。我们探讨了退伍军人对偶然发现的肺结节决策的看法。
我们对来自一个医疗中心的19名患有偶然发现的肺结节且被判定为恶性风险较低的退伍军人进行了半结构化的定性访谈。我们使用定性描述进行分析，重点关注患者对与他们的初级保健提供者（PCP）共同决策的看法。访谈于2011年和2012年进行。
在决定如何以及何时评估其肺结节是否有恶性可能时，患者几乎总是扮演被动角色。一些患者对这个角色感到满意，表达了对其临床医生会提供适当护理的信任。其他患者对这些决策的方式不满意，一些人表示担心实际上没有做出任何决策。无论他们对决策有多满意，患者都没有报告与他们的初级保健提供者讨论过他们喜欢如何做决策。
我们研究中的退伍军人没有与他们 的临床医生进行共同决策。一些人对这种方法感到满意，但许多人更喜欢共同决策的方法。为了减轻患者的痛苦并提高满意度，临床医生在做出关于肺结节评估的决策时可能需要考虑采用共同决策的方法。
