乳房切除术后乳房重建决策的信息充分程度如何？一项前瞻性横断面研究。
How Informed Is the Decision About Breast Reconstruction After Mastectomy?: A Prospective, Cross-sectional Study.
作者信息
Lee Clara Nan-Hi, Ubel Peter Anthony, Deal Allison M, Blizard Lillian Burdick, Sepucha Karen R, Ollila David W, Pignone Michael Patrick
机构信息
*Department of Surgery, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC†Department of Health Policy and Management, School of Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC‡Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, NC§Department of Marketing, Fuqua School of Business, Duke University, Durham, NC¶Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina Chapel Hill, Chapel Hill, NC||Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA**Department of Medicine, Massachusetts General Hospital, Boston, MA††Department of Medicine, Harvard Medical School, Boston, MA‡‡Department of Medicine, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC.
出版信息
Ann Surg. 2016 Dec;264(6):1103-1109. doi: 10.1097/SLA.0000000000001561.
OBJECTIVE
To assess how informed patients are about breast reconstruction, and how involved they are in decision making.
SUMMARY BACKGROUND DATA
Breast reconstruction is an important treatment option for patients undergoing mastectomy. Wide variations in who gets reconstruction, however, have led to concerns about decision making.
METHODS
We conducted a prospective cross-sectional study of patients planning mastectomy at a single site, over 20 months. Before surgery, patients completed a survey with validated scales to assess knowledge about breast reconstruction and involvement in decision making. Factors associated with knowledge were examined in a multivariable linear regression model.
RESULTS
A total of 145 patients enrolled (77% enrollment rate), and 126 remained eligible. The overall knowledge score was 58.5% (out of 100%). Knowledge about risk of complications was especially low at 14.3%. Knowledge did not differ by treatment (reconstruction or not). On multivariable analysis, non-white race was independently associated with lower knowledge. Most patients (92.1%) reported some discussion with a provider about reconstruction, and most (90.4%) reported being asked their preference. More patients reported discussing the advantages of reconstruction (57.9%) than the disadvantages (27.8%).
CONCLUSIONS
Women undergoing mastectomy in this sample were highly involved in decision making, but had major deficits in knowledge about the procedure. Knowledge about the risk of complications was particularly low. Providers seemed to have discussed the advantages of reconstruction more than its disadvantages.
目的
评估患者对乳房重建的了解程度以及他们在决策过程中的参与程度。
总结背景数据
乳房重建是接受乳房切除术患者的重要治疗选择。然而，接受重建手术的人群差异很大，这引发了对决策过程的担忧。
方法
我们在单一地点对计划接受乳房切除术的患者进行了为期20个月的前瞻性横断面研究。手术前，患者完成了一项使用经过验证的量表的调查，以评估对乳房重建的了解程度和参与决策的情况。在多变量线性回归模型中研究了与知识相关的因素。
结果
共有145名患者入组（入组率77%），126名仍符合条件。总体知识得分是58.5%（满分100%）。关于并发症风险的知识尤其低，仅为14.3%。知识水平在不同治疗方式（是否进行重建）之间没有差异。在多变量分析中，非白人种族与较低的知识水平独立相关。大多数患者（92.1%）报告与医疗服务提供者就重建问题进行了一些讨论，大多数（90.4%）报告被询问了他们的偏好。更多患者报告讨论了重建的优点（57.9%），而不是缺点（27.8%）。
结论
该样本中接受乳房切除术的女性高度参与决策，但对该手术的知识存在重大欠缺。关于并发症风险的知识尤其低。医疗服务提供者似乎更多地讨论了重建的优点而非缺点。
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