Nies Yong Hui, Islahudin Farida, Chong Wei Wen, Abdullah Norlia, Ismail Fuad, Ahmad Bustamam Ros Suzanna, Wong Yoke Fui, Saladina J J, Mohamed Shah Noraida
Faculty of Pharmacy.
Department of Surgery.
Patient Prefer Adherence. 2017 Oct 16;11:1767-1777. doi: 10.2147/PPA.S143611. eCollection 2017.
This study investigated breast cancer patients' involvement level in the treatment decision-making process and the concordance between patients' and physician's perspectives in decision-making.
A cross-sectional study was conducted involving physicians and newly diagnosed breast cancer patients from three public/teaching hospitals in Malaysia. The Control Preference Scale (CPS) was administered to patients and physicians, and the Krantz Health Opinion Survey (KHOS) was completed by the patients alone. Binary logistic regression was used to determine the association between sociodemographic characteristics, the patients' involvement in treatment decision-making, and patients' preference for behavioral involvement and information related to their disease.
The majority of patients preferred to share decision-making with their physicians (47.5%), while the second largest group preferred being passive (42.6%) and a small number preferred being active (9.8%). However, the physicians perceived that the majority of patients preferred active decision-making (56.9%), followed by those who desired shared decision-making (32.8%), and those who preferred passive decision-making (10.3%). The overall concordance was 26.5% (54 of 204 patient-physician dyads). The median of preference for information score and behavioral involvement score was 4 (interquartile range [IQR] =3-5) and 2 (IQR =2-3), respectively. In univariate analysis, the ethnicity and educational qualification of patients were significantly associated with the patients' preferred role in the process of treatment decision-making and the patients' preference for information seeking (>0.05). However, only educational qualification (=0.004) was significantly associated with patients' preference for information seeking in multivariate analysis.
Physicians failed to understand patients' perspectives and preferences in treatment decision-making. The concordance between physicians' perception and patients' perception was quite low as the physicians perceived that more than half of the patients were active in treatment decision-making. In actuality, more than half of patients perceived that they shared decision-making with their physicians.
本研究调查了乳腺癌患者在治疗决策过程中的参与程度以及患者与医生在决策方面观点的一致性。
进行了一项横断面研究，涉及马来西亚三家公立/教学医院的医生和新诊断的乳腺癌患者。对患者和医生使用了控制偏好量表（CPS），患者单独完成了克兰茨健康意见调查（KHOS）。采用二元逻辑回归来确定社会人口学特征、患者在治疗决策中的参与度以及患者对行为参与和疾病相关信息的偏好之间的关联。
大多数患者倾向于与医生共同决策（47.5%），而第二大群体倾向于被动（42.6%），少数患者倾向于主动（9.8%）。然而，医生认为大多数患者倾向于主动决策（56.9%），其次是希望共同决策的患者（32.8%），以及倾向于被动决策的患者（10.3%）。总体一致性为26.5%（204对患者 - 医生组合中有54对）。信息偏好得分和行为参与得分的中位数分别为4（四分位间距[IQR]=3 - 5）和2（IQR =2 - 3）。在单因素分析中，患者的种族和教育程度与患者在治疗决策过程中偏好的角色以及患者对信息寻求的偏好显著相关（>0.05）。然而，在多因素分析中，只有教育程度（=0.004）与患者对信息寻求的偏好显著相关。
医生未能理解患者在治疗决策中的观点和偏好。医生的认知与患者的认知之间的一致性相当低，因为医生认为超过一半的患者在治疗决策中较为主动。实际上，超过一半的患者认为他们是与医生共同决策。
