Miles A, Chronakis I, Fox J, Mayer A
Birkbeck, University of London, London, UK.
University College London, London, UK.
BMJ Open. 2017 Mar 24;7(3):e012935. doi: 10.1136/bmjopen-2016-012935.
To develop a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer, and examine perceived usefulness, acceptability and areas for improvement of the DA.
Mixed methods.
Single outpatient oncology department in central London.
Consecutive recruitment of 13 patients with stage II colorectal cancer, 12 of whom completed the study. Inclusion criteria were: age >18 years; complete resection for stage II adenocarcinoma of the colon or rectum; patients within 14-56 days after surgery; no contraindication to adjuvant chemotherapy; able to give written informed consent. Exclusion criterion: previous chemotherapy.
Patient perceived usefulness (assessed by the PrepDM questionnaire) and acceptability of the DA.
PrepDM scores, measuring the perceived usefulness of the DA in preparing the patient to communicate with their doctor and make a health decision, were above those reported in other patient groups. Patient acceptability scores were also high; however, interviews showed that there was evidence of a lack of understanding of key information among some patients, in particular their baseline risk of recurrence, the net benefit of combination chemotherapy and the rationale for having chemotherapy when cancer had apparently gone.
Patients found the DA acceptable and useful in supporting their decision about whether or not to have adjuvant chemotherapy. Suggested improvements for the DA include: sequential presentation of treatment options (eg, no treatment vs 1 drug, 1 drug vs 2 drugs) to enhance patient understanding of the difference between combination and single therapy, diagrams to help patients understand the rationale for chemotherapy to prevent a recurrence and inbuilt checks on patient understanding of baseline risk of recurrence and net benefit of chemotherapy.
开发一种计算机化决策辅助工具（DA），为II期结直肠癌患者辅助化疗的决策过程提供信息，并评估该决策辅助工具的感知有用性、可接受性及改进方向。
混合方法。
伦敦市中心的单一门诊肿瘤科。
连续招募13例II期结直肠癌患者，其中12例完成研究。纳入标准为：年龄>18岁；结肠或直肠II期腺癌完全切除；术后14 - 56天内的患者；无辅助化疗禁忌证；能够给予书面知情同意。排除标准：既往接受过化疗。
患者对决策辅助工具的感知有用性（通过PrepDM问卷评估）及可接受性。
PrepDM评分用于衡量决策辅助工具在帮助患者与医生沟通及做出健康决策方面的感知有用性，高于其他患者群体的报告评分。患者的可接受性评分也很高；然而，访谈显示部分患者存在对关键信息理解不足的情况，特别是他们的复发基线风险、联合化疗的净获益以及癌症明显消失后仍进行化疗的理由。
患者认为该决策辅助工具在支持其关于是否接受辅助化疗的决策方面是可接受且有用的。对决策辅助工具的改进建议包括：按顺序呈现治疗方案（如，不治疗对比单药治疗、单药治疗对比两药治疗），以增强患者对联合治疗和单一治疗差异的理解；使用图表帮助患者理解化疗预防复发的原理；内置检查以确保患者理解复发基线风险及化疗净获益。
