肺癌临床医生对早期非小细胞肺癌共同决策的看法。
Opinions of lung cancer clinicians on shared decision making in early-stage non-small-cell lung cancer.
作者信息
Mokhles Sahar, Maat Alex P W M, Aerts Joachim G J V, Nuyttens Joost J M E, Bogers Ad J J C, Takkenberg Johanna J M
机构信息
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands.
Department of Pulmonary Disease, Erasmus MC, Rotterdam, Netherlands.
出版信息
Interact Cardiovasc Thorac Surg. 2017 Aug 1;25(2):278-284. doi: 10.1093/icvts/ivx103.
OBJECTIVES
To investigate the opinions of lung cancer clinicians concerning shared decision making (SDM) in early-stage non-small-cell lung cancer patients.
METHODS
A survey was conducted among Dutch cardiothoracic surgeons and lung surgeons, pulmonologists and radiation oncologists. The opinions of clinicians on the involvement of patients in treatment decision making was assessed using a 1-5 Likert-type scale. Through open questions, we queried barriers to and drivers of SDM in clinical practice. Clinicians were asked to review 7 hypothetical cases and indicate which treatment strategy they would choose using a 1-7 Likert-type scale.
RESULTS
Twenty-six percent of surgeons, 20% of pulmonologists and 12% of radiation oncologists indicated that they always engage in SDM (16% missing; P-value = 0.10). Most respondents stated that, ideally, doctors and patients should decide together (surgeons 52%, pulmonologists 67% and radiation oncologists 35%; P-value = 0.005). Thirty percent of surgeons, 27% of pulmonologists and 44% of radiation oncologists indicated that doctors are not properly trained to implement SDM in clinical practice (P-value = 0.37). SDM may not always be feasible due to low patient education level and minimal knowledge about lung cancer. Wide variations in the clinicians' lung cancer treatment preferences were observed in the responses to the hypothetical cases.
CONCLUSIONS
In current clinical decision making in lung cancer treatment, a majority of clinicians agree that it is important to involve lung cancer patients in treatment decision making but that time constraints and the inability of some patients to make a weighted decision are important barriers. The observed variation in lung cancer treatment preferences among clinicians suggests that for most patients both surgery and radiotherapy are suitable options, and it underlines the sensitive nature of treatment choices in early-stage non-small-cell lung cancer.
目的
调查肺癌临床医生对于早期非小细胞肺癌患者共同决策（SDM）的看法。
方法
对荷兰心胸外科医生、肺外科医生、呼吸科医生和放射肿瘤学家进行了一项调查。使用1-5李克特量表评估临床医生对患者参与治疗决策的看法。通过开放式问题，我们询问了临床实践中共同决策的障碍和驱动因素。要求临床医生回顾7个假设病例，并使用1-7李克特量表指出他们会选择哪种治疗策略。
结果
26%的外科医生、20%的呼吸科医生和12%的放射肿瘤学家表示他们总是参与共同决策（16%未作答；P值=0.10）。大多数受访者表示，理想情况下，医生和患者应该共同做出决定（外科医生为52%，呼吸科医生为67%，放射肿瘤学家为35%；P值=0.005）。30%的外科医生、27%的呼吸科医生和44%的放射肿瘤学家表示，医生在临床实践中没有接受适当的培训来实施共同决策（P值=0.37）。由于患者教育水平低和对肺癌的了解有限，共同决策可能并不总是可行的。在对假设病例的回答中，观察到临床医生对肺癌治疗偏好的广泛差异。
结论
在当前肺癌治疗的临床决策中，大多数临床医生一致认为让肺癌患者参与治疗决策很重要，但时间限制和一些患者无法做出权衡决定是重要障碍。临床医生对肺癌治疗偏好的差异表明，对大多数患者来说，手术和放疗都是合适的选择，这凸显了早期非小细胞肺癌治疗选择的敏感性。
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