Berry Donna L, Nayak Manan, Halpenny Barbara, Harrington Shannon, Loughlin Kevin R, Chang Peter, Rosenberg Jonathan E, Kibel Adam S
The Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA.
Division of Urologic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Bladder Cancer. 2015 Oct 26;1(2):151-158. doi: 10.3233/BLC-150029.
Each stage of bladder cancer involves varying treatment issues and concerns that are discussed between patients and providers during the pre-treatment consultation. There is no documentation of how patients engage in decision making. To describe aspects of treatment decision making perceived by patients with bladder cancer using qualitative analysis of data from individual interviews. Patients with any stage bladder cancer were recruited from urology and medical oncology services at a comprehensive cancer center. A qualitative approach to data collection and analysis was applied. Individual, semi-structured interviews were conducted, recorded and transcribed. Coding of the transcripts was conducted by research team members, discussed for consensus and major themes derived. 45 men and 15 women, the majority college educated, were recruited. Where to receive care, including from whom, was the initial and major decision. Challenges of decisions regarding urinary reconstruction were dominant. Personal characteristics, including age and being active, were considered. Participants with early stage tumors ( = 28) typically perceived only one treatment option and followed the physician's recommendation. The 18 participants with stage II-III were aware of multiple options. In 14 stage IV participants, balancing quality of life and outcomes between treatments was common to the decision process. For this educated sample with bladder cancer, recruited at a comprehensive cancer center, the major decision was to seek treatment at a location with the highest level of physician expertise. Personal preferences informed decisions surrounding bladder reconstruction. Further research will be conducted in a diverse sample of patients making decisions in a non-urban, community setting.
膀胱癌的每个阶段都涉及不同的治疗问题和关注点，这些在治疗前咨询期间会由患者和医疗服务提供者进行讨论。目前没有关于患者如何参与决策制定的记录。通过对个体访谈数据进行定性分析，来描述膀胱癌患者所感知的治疗决策制定的各个方面。从一家综合癌症中心的泌尿外科和医学肿瘤服务部门招募了处于任何阶段的膀胱癌患者。采用了定性的数据收集和分析方法。进行了个体、半结构化访谈，并进行记录和转录。研究团队成员对访谈记录进行编码，经讨论达成共识并得出主要主题。共招募了45名男性和15名女性，其中大多数人受过大学教育。在哪里接受治疗，包括由谁提供治疗，是最初也是主要的决策。关于尿路重建的决策挑战最为突出。还考虑了个人特征，包括年龄和是否活跃。早期肿瘤患者（n = 28）通常只看到一种治疗选择，并遵循医生的建议。18名II - III期患者意识到有多种选择。在14名IV期患者中，在治疗之间平衡生活质量和治疗结果是决策过程中的常见情况。对于这个在综合癌症中心招募的、受过良好教育的膀胱癌样本，主要决策是在医生专业水平最高的地方寻求治疗。个人偏好影响了围绕膀胱重建的决策。未来将在非城市社区环境中做出决策的不同患者样本中开展进一步研究。
