Department of Palliative Medicine,Centre Hospitalier de Lyon-Sud,Hospices Civils de Lyon,Pierre-Bénite,France.
Department of Palliative Care and Rehabilitation Medicine,University of Texas MD Anderson Cancer Center,Houston,Texas,USA.
Palliat Support Care. 2018 Oct;16(5):544-551. doi: 10.1017/S1478951517000803. Epub 2017 Nov 2.
ABSTRACTObjective:Understanding patients' decisional control preferences (DCPs) is important to improving the quality of care and the satisfaction of patients who have advanced cancer with their care. In addition to passive decisional control (i.e., the patient prefers his/her doctor or family caregiver to make a decision on their behalf) and active decisional control (i.e., the patient decides alone), shared decisional control, where patients and caregivers decide together, could be more appropriate. The primary aim of our study was to describe the decision-making process and the DCPs of patients with advanced cancer receiving palliative care in France.
We conducted a prospective survey with advanced cancer patients referred to a palliative care team in an outpatient setting. We collected information about patients' demographic and clinical characteristics using the Decision Control Preference Scale, the Satisfaction with the Decisions and Care questionnaire, and the Understanding of Illness questionnaire.
A total of 200 patients were evaluable. The median age was 63.5 years and 53.5% female. The cancers most commonly represented were gastrointestinal and breast. A total of 72 patients (36.2%) preferred active decisional control, 52 (26.1%) preferred shared decisional control, and 75 (37.7%) preferred passive decisional control. Younger age (p = 0.003), higher education (p < 0.001), and employment status (p = 0.046) were found to be associated with active or shared DCPs. Some 82% of patients were satisfied with the decision-making process, 35% of whom expressed wishes that did not match the actual decision-making process. Only 23% of patients thought they could be cured of their illness, and 47% thought that their treatment would "get rid of " their disease.
The decision-making processes are shared in the three models of DCPs in our cohort of French patients with advanced cancer. Further prospective studies are needed.
摘要
了解患者的决策控制偏好（DCP）对于提高接受姑息治疗的晚期癌症患者的护理质量和满意度非常重要。除了被动决策控制（即患者希望其医生或家庭照顾者代表他们做出决策）和主动决策控制（即患者独自做出决策）外，患者和照顾者共同做出决策的共享决策控制可能更为合适。我们研究的主要目的是描述法国接受姑息治疗的晚期癌症患者的决策过程和 DCP。
我们对在门诊环境下接受姑息治疗团队治疗的晚期癌症患者进行了前瞻性调查。我们使用决策控制偏好量表、决策和护理满意度问卷以及疾病理解问卷收集了患者的人口统计学和临床特征信息。
共 200 例患者可评估。中位年龄为 63.5 岁，53.5%为女性。最常见的癌症是胃肠道和乳腺癌。共有 72 例（36.2%）患者偏爱主动决策控制，52 例（26.1%）偏爱共享决策控制，75 例（37.7%）偏爱被动决策控制。年轻（p = 0.003）、高教育程度（p < 0.001）和就业状态（p = 0.046）与主动或共享 DCP 相关。82%的患者对决策过程感到满意，其中 35%的患者表达了与实际决策过程不符的意愿。只有 23%的患者认为自己可以治愈疾病，47%的患者认为自己的治疗可以“消除”疾病。
在我们的法国晚期癌症患者队列中，三种 DCP 模型的决策过程都是共享的。需要进一步的前瞻性研究。
