Thornton Raymond H, Dauer Lawrence T, Shuk Elyse, Bylund Carma L, Banerjee Smita C, Maloney Erin, Fox Lindsey B, Beattie Christopher M, Hricak Hedvig, Hay Jennifer
From the Departments of Radiology (R.H.T., L.T.D., L.B.F., C.M.B., H.H.), Medical Physics (L.T.D.), and Psychiatry and Behavioral Sciences (E.S., C.L.B., S.C.B., E.M., J.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, Suite H118, New York, NY 10065.
Radiology. 2015 May;275(2):545-52. doi: 10.1148/radiol.15132905. Epub 2015 Mar 24.
To identify opportunities for improving patient-centered communication about diagnostic imaging tests that involve the use of radiation in a cancer care setting.
Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. Patient knowledge, information sources, and communication preferences were assessed in six focus groups during 2012. The groups consisted of patients undergoing treatment for metastatic colorectal carcinoma, women treated within the past 6 months for early-stage breast carcinoma, men undergoing surveillance after testicular cancer treatment, parents of patients treated for stage I-III neuroblastoma, patients in a thoracic oncology survivorship program, and participants in a lung cancer screening program. A multidisciplinary research team performed thematic content analysis of focus group transcripts. High-level findings were summarized during consensus conferences.
Although they were aware of the long-term risk of cancer from exposure to ionizing radiation, most participants reported that their health care provider did not initiate discussion about benefits and risks of radiation from imaging tests. Most patients obtained information by means of self-directed internet searches. Participants expressed gratitude for tests ("That CT saved my daughter's life," "I'd rather have the radiation dosage than being opened up"), yet they expressed concern about having to initiate discussions ("If you don't ask, nobody is going to tell you anything") and the desire to be offered information concerning the rationale for ordering specific imaging examinations, intervals for follow-up imaging, and testing alternatives. Participants believed that such information should be available routinely and that conversation with their personal physician or endorsed, readily available reference materials were ideal methods for information exchange. Understanding imaging radiation risks and active participation in decision making about imaging were especially important to cancer survivors.
A substantial gap exists between patient expectations and current practices for providing information about medical imaging tests that involve the use of radiation.
确定在癌症护理环境中改善有关涉及辐射的诊断成像检查的以患者为中心沟通的机会。
本符合《健康保险流通与责任法案》的研究获得了机构审查委员会的批准并取得了知情同意。2012年期间，在六个焦点小组中评估了患者的知识、信息来源和沟通偏好。这些小组包括正在接受转移性结直肠癌治疗的患者、过去6个月内接受早期乳腺癌治疗的女性、睾丸癌治疗后接受监测的男性、接受I - III期神经母细胞瘤治疗患者的父母、胸科肿瘤幸存者计划中的患者以及肺癌筛查计划的参与者。一个多学科研究团队对焦点小组记录进行了主题内容分析。在共识会议期间总结了高层次的研究结果。
尽管大多数参与者意识到暴露于电离辐射会带来患癌的长期风险，但他们表示其医疗服务提供者并未开始讨论成像检查辐射的益处和风险。大多数患者通过自主的互联网搜索获取信息。参与者对检查表示感激（“那次CT救了我女儿的命”，“我宁愿接受辐射剂量也不愿开刀”），然而他们对不得不主动发起讨论表示担忧（“如果你不问，没人会告诉你任何事”），并且希望能获得有关开具特定成像检查的理由、后续成像检查的间隔时间以及检查替代方案的信息。参与者认为此类信息应常规提供，并且与他们的私人医生交谈或参考认可的、易于获取的参考资料是理想的信息交流方式。了解成像辐射风险并积极参与有关成像的决策对癌症幸存者尤为重要。
在患者对涉及辐射的医学成像检查信息的期望与当前提供信息的实践之间存在巨大差距。
