Schleidgen Sebastian, Thiersch Sandra, Wuerstlein Rachel, Marckmann Georg
Pflegewissenschaftliche Fakultät, Philosophisch-Theologische Hochschule Vallendar, Vallendar, Germany.
Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Germany.
Geburtshilfe Frauenheilkd. 2017 Sep;77(9):984-992. doi: 10.1055/s-0043-115396. Epub 2017 Sep 25.
In recent years, the hopes and expectations associated with so-called individualized medicine have been the subject of intense debate as has the medical potential of this approach. Questions about the uses of gene expression analyses for decisions on adjuvant systemic treatment options for patients with breast cancer have played a prominent role in this debate. There are a number of empirical studies on the effect of gene expression tests on the therapy decisions of physicians and the potentially conflicted decisions for patients. Very little attention has been paid to how patients perceive such approaches, the extent to which they feel included in the therapy decision, and the expectations they associate with such an approach.
Using qualitative explorative interviews, the study looked at how well patients with breast cancer understood the individualized treatment approaches and examined patients' experiences and expectations with regard to gene expression analyses. The sample consisted of 8 patients who were diagnosed with primary hormone receptor-positive, HER2-negative breast cancer between 2013 and 2014 and who underwent gene expression analyses as part of their adjuvant therapy planning.
Patients were found to have a quite realistic view of the benefits of gene expression analyses, although it also became clear that the treatment could also raise false hopes. The statements by the interviewed women also illustrated the necessity of continuing to explore the possibilities and limits to joint decision-making in such complex medical contexts as individualized molecular genomic medicine. And finally, the interviews reflected the hope for individualized treatment in the broadest sense of the word.
The results of the study highlight the challenge of taking psychosocial aspects of medical treatment sufficiently into consideration, given the ever increasing options for molecular genomic individualization.
近年来，与所谓的个性化医疗相关的希望和期望一直是激烈辩论的主题，这种方法的医学潜力也是如此。关于基因表达分析在乳腺癌患者辅助全身治疗方案决策中的应用问题在这场辩论中发挥了突出作用。有许多实证研究探讨了基因表达检测对医生治疗决策的影响以及给患者带来的潜在矛盾决策。然而，很少有人关注患者如何看待这种方法，他们在多大程度上感觉自己参与了治疗决策，以及他们对这种方法的期望。
本研究通过定性探索性访谈，考察了乳腺癌患者对个性化治疗方法的理解程度，并审视了患者在基因表达分析方面的经历和期望。样本包括8名在2013年至2014年间被诊断为原发性激素受体阳性、HER2阴性乳腺癌的患者，她们在辅助治疗规划中接受了基因表达分析。
研究发现患者对基因表达分析的益处有着较为现实的看法，不过也很明显这种治疗也可能带来不切实际的希望。受访女性的陈述还表明，在个性化分子基因组医学这种复杂的医疗背景下，有必要继续探索共同决策的可能性和局限性。最后，访谈反映了患者对最广义个性化治疗的期望。
研究结果凸显了在分子基因组个体化选择日益增多的情况下，充分考虑医疗心理社会因素所面临的挑战。
