影响医生在生命末期向癌症患者传达个性化预后信息意愿的因素：一项实验性 vignette 研究
Factors Affecting Physicians' Intentions to Communicate Personalized Prognostic Information to Cancer Patients at the End of Life: An Experimental Vignette Study.
作者信息
Han Paul K J, Dieckmann Nathan F, Holt Christina, Gutheil Caitlin, Peters Ellen
机构信息
Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH, CG)
Tufts University Clinical and Translational Sciences Institute, Boston, MA (PKJH)
出版信息
Med Decis Making. 2016 Aug;36(6):703-13. doi: 10.1177/0272989X16638321. Epub 2016 Mar 16.
PURPOSE
To explore the effects of personalized prognostic information on physicians' intentions to communicate prognosis to cancer patients at the end of life, and to identify factors that moderate these effects.
METHODS
A factorial experiment was conducted in which 93 family medicine physicians were presented with a hypothetical vignette depicting an end-stage gastric cancer patient seeking prognostic information. Physicians' intentions to communicate prognosis were assessed before and after provision of personalized prognostic information, while emotional distress of the patient and ambiguity (imprecision) of the prognostic estimate were varied between subjects. General linear models were used to test the effects of personalized prognostic information, patient distress, and ambiguity on prognostic communication intentions, and potential moderating effects of 1) perceived patient distress, 2) perceived credibility of prognostic models, 3) physician numeracy (objective and subjective), and 4) physician aversion to risk and ambiguity.
RESULTS
Provision of personalized prognostic information increased prognostic communication intentions (P < 0.001, η(2) = 0.38), although experimentally manipulated patient distress and prognostic ambiguity had no effects. Greater change in communication intentions was positively associated with higher perceived credibility of prognostic models (P = 0.007, η(2) = 0.10), higher objective numeracy (P = 0.01, η(2) = 0.09), female sex (P = 0.01, η(2) = 0.08), and lower perceived patient distress (P = 0.02, η(2) = 0.07). Intentions to communicate available personalized prognostic information were positively associated with higher perceived credibility of prognostic models (P = 0.02, η(2) = 0.09), higher subjective numeracy (P = 0.02, η(2) = 0.08), and lower ambiguity aversion (P = 0.06, η(2) = 0.04).
CONCLUSIONS
Provision of personalized prognostic information increases physicians' prognostic communication intentions to a hypothetical end-stage cancer patient, and situational and physician characteristics moderate this effect. More research is needed to confirm these findings and elucidate the determinants of prognostic communication at the end of life.
目的
探讨个性化预后信息对医生在生命末期向癌症患者传达预后的意愿的影响，并确定调节这些影响的因素。
方法
进行了一项析因实验，向93名家庭医学医生展示了一个假设的病例 vignette，描述了一名晚期胃癌患者寻求预后信息。在提供个性化预后信息之前和之后评估医生传达预后的意愿，同时在受试者之间改变患者的情绪困扰和预后估计的模糊性（不精确性）。使用一般线性模型来测试个性化预后信息、患者困扰和模糊性对预后沟通意愿的影响，以及1）感知到的患者困扰、2）预后模型的感知可信度、3）医生的数字能力（客观和主观）和4）医生对风险和模糊性的厌恶的潜在调节作用。
结果
提供个性化预后信息增加了预后沟通意愿（P < 0.001，η(2) = 0.38），尽管实验操纵的患者困扰和预后模糊性没有影响。沟通意愿的更大变化与预后模型的更高感知可信度（P = 0.007，η(2) = 0.10）、更高的客观数字能力（P = 0.01，η(2) = 0.09）、女性性别（P = 0.01，η(2) = 0.08）以及更低的感知患者困扰（P = 0.02，η(2) = 0.07）呈正相关。传达可用个性化预后信息的意愿与预后模型的更高感知可信度（P = 0.02，η(2) = 0.09）、更高的主观数字能力（P = 0.02，η(2) = 0.08）以及更低的模糊性厌恶（P = 0.06，η(2) = 0.04）呈正相关。
结论
提供个性化预后信息增加了医生对假设的晚期癌症患者的预后沟通意愿，情境和医生特征调节了这种影响。需要更多研究来证实这些发现并阐明生命末期预后沟通的决定因素。
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