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探讨肿瘤护理中的分子检测:比较患者和医生的信息偏好。

Discussing molecular testing in oncology care: Comparing patient and physician information preferences.

作者信息

Pinheiro Ana P M, Pocock Rachel H, Switchenko Jeffrey M, Dixon Margie D, Shaib Walid L, Ramalingam Suresh S, Pentz Rebecca D

机构信息

Department of Hematology and Oncology, Winship Cancer Institute, Atlanta, Georgia.

Emory University School of Medicine, Atlanta, Georgia.

出版信息

Cancer. 2017 May 1;123(9):1610-1616. doi: 10.1002/cncr.30494. Epub 2017 Jan 31.

Abstract

BACKGROUND

Molecular testing to inform treatment and clinical trial choices is now the standard of care for several types of cancer. However, no established guidelines exist for the type of information physicians should cover during discussions with the patient about the test or its results. The objectives of this study were to identify physician and patient preferences regarding information and who should communicate this information and how to inform guidelines for these conversations.

METHODS

Physicians and patients who participated in discussions regarding molecular testing were asked to choose 8 topics of most relevance out of a list of 18. The McNemar test was used to determine their top preferences. Patients were asked to identify what information they wanted to receive and who should inform them, and physicians were asked to identify the best aid to communication.

RESULTS

Sixty-six patients identified 12 preferred topics: the benefits of testing (88%), how testing determines treatment (88%), implications for family (71%), whether a test indicates the seriousness of disease (68%), purpose of the test (64%), incidental findings (56%), explanation of cancer genetics (53%), how the test is done (46%), limitations (44%), explanation of biomarker (42%), risks (42%), and uninformative results (38%). Physicians added cost (59%). Patients preferred receiving information about molecular testing from their nurse or physician (85%), and physicians preferred using a pamphlet (67%) to augment communication.

CONCLUSIONS

The topics identified as important to discuss can inform future guidelines and can contribute to effective communication regarding molecular testing. Cancer 2017;123:1610-1616. © 2017 American Cancer Society.

摘要

背景

用于指导治疗和临床试验选择的分子检测现已成为多种癌症的标准治疗手段。然而,对于医生在与患者讨论检测或其结果时应涵盖的信息类型,尚无既定指南。本研究的目的是确定医生和患者在信息方面的偏好,以及应由谁来传达这些信息,从而为这些对话的指南提供参考。

方法

参与分子检测讨论的医生和患者被要求从18个主题列表中选出8个最相关的主题。采用 McNemar 检验来确定他们的首要偏好。患者被问及他们希望获得哪些信息以及应由谁告知他们,医生则被问及最佳的沟通辅助工具是什么。

结果

66名患者确定了12个偏好主题:检测的益处(88%)、检测如何决定治疗(88%)、对家庭的影响(71%)、检测是否表明疾病的严重程度(68%)、检测目的(64%)、偶然发现(56%)、癌症遗传学解释(53%)、检测如何进行(46%)、局限性(44%)、生物标志物解释(42%)、风险(42%)以及无信息价值的结果(38%)。医生补充了费用(59%)。患者更倾向于从护士或医生那里获得有关分子检测的信息(85%),而医生更倾向于使用宣传册(67%)来加强沟通。

结论

确定为重要讨论内容的主题可为未来指南提供参考,并有助于就分子检测进行有效的沟通。《癌症》2017年;123:1610 - 1616。© 2017美国癌症协会。

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