Department of Medical Psychology, Amsterdam, The Netherlands
Department of Medical Psychology, Amsterdam, The Netherlands.
Oncologist. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. Epub 2017 Jun 12.
Although patient-driven second opinions are increasingly sought in oncology, the desirability of this trend remains unknown. Therefore, this systematic review assesses evidence on the motivation for and frequency of requests for second opinions and examines how they evolve and their consequences for oncological practice.
Relevant databases were sought using the terms "cancer," "second opinion," and "self-initiated." Included were peer-reviewed articles that reported on patient-initiated second opinions within oncology. Selection, data extraction, and quality assessment were performed and discussed by two researchers.
Of the 25 included studies, the methodological designs were qualitative ( = 4), mixed ( = 1), or quantitative ( = 20). Study quality was rated high for 10 studies, moderate for eight, and low for seven studies. Reported rates of second opinion seeking ranged from 1%-88%. Higher education was most consistently related to seeking a second opinion. Patients' primary motivations were a perceived need for certainty or confirmation, a lack of trust, dissatisfaction with communication, and/or a need for more (personalized) information. Reported rates of diagnostic or therapeutic discrepancies between the first and second opinions ranged from 2%-51%.
Additional studies are required to further examine the medical, practical, and psychological consequences of second opinions for patients and oncologists. Future studies could compare the potential advantages and disadvantages of second opinion seeking, and might offer guidance to patients and physicians to better facilitate the second opinion process. Some practical recommendations are provided for oncologists to optimally discuss and conduct second opinions with their patients. 2017;22:1197-1211 IMPLICATIONS FOR PRACTICE: Although cancer patients increasingly seek a second opinion, the benefits of this process remain unclear. Results of this systematic review suggest that the available studies on this topic are highly variable in both methodology and quality. Moreover, reported rates for a second opinion (1%-88%) as well as for disagreement between the first and second opinion (2%-51%) range widely. The primary motivations of patients are a need for certainty, lack of trust, dissatisfaction with communication, and/or a need for more (personalized) information. Additional research should evaluate how unnecessary second opinions might be avoided. Practical suggestions are provided for oncologists to optimize second opinions.
尽管患者驱动的二次意见在肿瘤学中越来越受到关注，但这种趋势的可取性尚不清楚。因此，本系统评价评估了寻求二次意见的动机和频率的证据，并研究了它们的演变及其对肿瘤学实践的影响。
使用“癌症”、“二次意见”和“自我发起”等术语在相关数据库中进行搜索。纳入了报告肿瘤学中患者发起的二次意见的同行评议文章。由两名研究人员进行选择、数据提取和质量评估，并进行讨论。
在 25 项纳入的研究中，方法设计为定性（ = 4）、混合（ = 1）或定量（ = 20）。10 项研究的研究质量评价为高，8 项为中，7 项为低。报告的寻求二次意见的比例从 1%-88%不等。较高的教育程度与寻求二次意见最一致。患者的主要动机是对确定性或确认的需求、缺乏信任、对沟通的不满以及/或对更多（个性化）信息的需求。报告的第一次和第二次意见之间的诊断或治疗差异率从 2%-51%不等。
需要进一步研究二次意见对患者和肿瘤医生的医疗、实践和心理影响。未来的研究可以比较寻求二次意见的潜在优缺点，并可能为患者和医生提供指导，以更好地促进二次意见过程。为肿瘤医生提供了一些实用建议，以优化与患者的讨论和进行二次意见。2017 年；22:1197-1211。
尽管癌症患者越来越多地寻求二次意见，但该过程的益处仍不清楚。本系统评价的结果表明，关于该主题的现有研究在方法和质量上差异很大。此外，报告的二次意见率（1%-88%）以及第一次和第二次意见之间的不一致率（2%-51%）差异很大。患者的主要动机是对确定性、缺乏信任、对沟通的不满以及/或对更多（个性化）信息的需求。应进行更多研究评估如何避免不必要的二次意见。为肿瘤医生提供了一些实用建议，以优化二次意见。
