Hawley Sarah T, Griffith Kent A, Hamilton Ann S, Ward Kevin C, Morrow Monica, Janz Nancy K, Katz Steven J, Jagsi Reshma
Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, Michigan.
Veterans Administration Center for Clinical Management Research, Ann Arbor VA Health Care System, Ann Arbor, Michigan.
Cancer. 2017 Dec 1;123(23):4547-4555. doi: 10.1002/cncr.30924. Epub 2017 Aug 15.
Little is known about how the individual decision styles and values of breast cancer patients at the time of treatment decision making are associated with the consideration of different treatment options and specifically with the consideration of contralateral prophylactic mastectomy (CPM).
Newly diagnosed patients with early-stage breast cancer who were treated in 2013-2014 were identified through the Surveillance, Epidemiology, and End Results registries of Los Angeles and Georgia and were surveyed approximately 7 months after surgery (n = 2578; response rate, 71%). The primary outcome was the consideration of CPM (strong vs less strong). The association between patients' values and decision styles and strong consideration was assessed with multivariate logistic regression.
Approximately one-quarter of women (25%) reported strong/very strong consideration of CPM, and another 29% considered it moderately/weakly. Decision styles, including a rational-intuitive approach to decision making, varied. The factors most valued by women at the time of treatment decision making were as follows: avoiding worry about recurrence (82%) and reducing the need for more surgery (73%). In a multivariate analysis, patients who preferred to make their own decisions, those who valued avoiding worry about recurrence, and those who valued avoiding radiation significantly more often strongly considered CPM (P < .05), whereas those who reported being more logical and those who valued keeping their breast did so less often.
Many patients considered CPM, and the consideration was associated with both decision styles and values. The variability in decision styles and values observed in this study suggests that formally evaluating these characteristics at or before the initial treatment encounter could provide an opportunity for improving patient clinician discussions. Cancer 2017;123:4547-4555. © 2017 American Cancer Society.
关于乳腺癌患者在治疗决策时的个人决策风格和价值观如何与不同治疗方案的考虑相关，特别是与对侧预防性乳房切除术（CPM）的考虑相关，目前所知甚少。
通过洛杉矶和佐治亚州的监测、流行病学和最终结果登记处识别出2013 - 2014年接受治疗的新诊断早期乳腺癌患者，并在术后约7个月对其进行调查（n = 2578；应答率为71%）。主要结局是对CPM的考虑（强烈与不太强烈）。通过多变量逻辑回归评估患者价值观和决策风格与强烈考虑之间的关联。
约四分之一的女性（25%）报告对CPM有强烈/非常强烈的考虑，另有29%的女性有中度/轻度考虑。决策风格各异，包括理性 - 直觉决策方法。女性在治疗决策时最看重的因素如下：避免担心复发（82%）和减少再次手术的需求（73%）。在多变量分析中，更喜欢自己做决定的患者、重视避免担心复发的患者以及重视避免放疗的患者更常强烈考虑CPM（P < .05），而那些报告更具逻辑性和重视保留乳房的患者则较少这样做。
许多患者考虑了CPM，这种考虑与决策风格和价值观都有关。本研究中观察到的决策风格和价值观的变异性表明，在初次治疗接触时或之前正式评估这些特征可能为改善医患讨论提供机会。《癌症》2017年；123:4547 - 4555。© 2017美国癌症协会。
