Wang Shi-Yi, Kelly Gabrielle, Gross Cary, Killelea Brigid K, Mougalian Sarah, Presley Carolyn, Fraenkel Liana, Evans Suzanne B
Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, Connecticut.
Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut.
Int J Radiat Oncol Biol Phys. 2017 Jul 15;98(4):733-740. doi: 10.1016/j.ijrobp.2017.02.001. Epub 2017 Feb 9.
To identify the information older women with early-stage breast cancer need when making radiation therapy decisions, and who patients identify as the main decision maker.
We surveyed (through face-to-face interview, telephone, or mail) women aged ≥65 years who received lumpectomy and were considering or receiving adjuvant radiation therapy for early-stage breast cancer. The survey instrument was constructed with input from patient and professional advisory committees, including breast cancer survivors, advocates of breast cancer care and aging, clinicians, and researchers. Participants rated the importance (on a 4-point scale) of 24 statements describing the benefits, side effects, impact on daily life, and other issues of radiation therapy in relation to radiation therapy decision making. Participants also designated who was considered the key decision maker.
The response rate was 56.4% (93 of 165). Mean age was 72.5 years, ranging from 65 to 93 years. More than 96% of participants indicated they were the main decision maker on receiving radiation therapy. There was wide variation in information needs regarding radiation therapy decision making. Participants rated a mean of 18 (range, 3-24) items as "essential." Participants rated items related to benefits highest, followed by side effects. Participants who were older than 75 years rated 13.9 questions as essential, whereas participants aged ≤74 years rated 18.7 as essential (P=.018).
Older women desire information and have more agency and input in the decision-making process than prior literature would suggest. The variation in information needs indicates that future decision support tools should provide options to select what information would be of interest to the participants.
确定早期乳腺癌老年女性在做出放射治疗决策时所需的信息,以及患者将谁视为主要决策者。
我们(通过面对面访谈、电话或邮件)对年龄≥65岁、接受了乳房肿瘤切除术且正在考虑或接受早期乳腺癌辅助放射治疗的女性进行了调查。调查问卷是在患者和专业咨询委员会(包括乳腺癌幸存者、乳腺癌护理与老龄化倡导者、临床医生和研究人员)的参与下构建的。参与者对24条描述放射治疗的益处、副作用、对日常生活的影响及其他与放射治疗决策相关问题的陈述的重要性进行评分(采用4分制)。参与者还指定了谁被视为关键决策者。
回复率为56.4%(165人中93人回复)。平均年龄为72.5岁,范围在65至93岁之间。超过96%的参与者表示她们是接受放射治疗的主要决策者。在放射治疗决策的信息需求方面存在很大差异。参与者平均将18条(范围为3 - 24条)陈述评为“必不可少”。参与者对与益处相关的陈述评分最高,其次是副作用。75岁以上的参与者将13.9个问题评为必不可少,而74岁及以下的参与者将18.7个问题评为必不可少(P = 0.018)。
与以往文献所表明的情况相比,老年女性渴望获取信息,并且在决策过程中有更多的自主权和参与度。信息需求的差异表明,未来的决策支持工具应提供选项,以便选择参与者感兴趣的信息。