Stratford, CT.
Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI; Department of Surgery, Alpert Medical School, Brown University, Providence, RI.
J Am Coll Surg. 2018 Feb;226(2):134-146.e3. doi: 10.1016/j.jamcollsurg.2017.10.022. Epub 2017 Dec 12.
Women diagnosed with breast cancer often describe the process of treatment decision making as bewildering and worrisome. Patients who do not feel completely informed about their surgical options might make choices that are suboptimal or regretted later. The Institute of Medicine has called for more research on why breast cancer patients are inadequately informed about treatment options. The aims of the study were to explore how women become informed about their breast cancer surgery treatment options and to identify improvement opportunities.
A nationwide internet survey was conducted among women who reported being surgically treated by lumpectomy only (n = 215), mastectomy only (n = 140), or by both procedures (n = 132) for breast cancer. To improve generalizability, Census-based enrollment quotas were applied for geographic region, health insurance, and income.
Only 47% (95% CI 41% to 54%) of lumpectomy-only patients, 67% (95% CI 59% to 75%) of mastectomy-only patients, and 28% (95% CI 21% to 35%) of patients having both procedures said they felt "completely informed" about treatment options before their operations. "Making a quick decision" was more important than "thoroughly researching all options" for 35% of lumpectomy-only patients, 31% of mastectomy-only patients, and 22% of patients having both procedures. Nearly all women used some other source of information to research treatment options. Lumpectomy-only and mastectomy-only patients who relied on their surgeon's recommendation without additional research were significantly less likely to report feeling "completely informed" (odds ratio 0.6; 95% CI 0.4 to 0.9; p < 0.02).
Many women who had surgery for breast cancer did not feel completely informed about their surgical options. This appears to be due, in part, to a false sense of urgency and perhaps insufficient or misdirected information gathering by patients. The responsibility for fully informing patients about their treatment options must be better fulfilled by surgeons.
被诊断患有乳腺癌的女性通常会表示，她们在进行治疗决策时感到困惑和担忧。那些对自己的手术选择没有完全了解的患者可能会做出不理想或后来后悔的选择。美国国家医学研究院呼吁开展更多研究，以了解为什么乳腺癌患者对治疗选择了解不足。本研究的目的是探讨女性如何了解其乳腺癌手术治疗选择，并确定改进机会。
对仅接受保乳手术（n=215）、仅接受乳房切除术（n=140）或这两种手术（n=132）治疗乳腺癌的女性进行了全国性的互联网调查。为了提高普遍性，采用了基于人口普查的地理区域、健康保险和收入的配额纳入。
仅 47%（95%CI 41%至 54%）的保乳手术患者、67%（95%CI 59%至 75%）的乳房切除术患者和 28%（95%CI 21%至 35%）的两种手术都做的患者表示，在手术前他们对治疗选择“完全了解”。对于 35%的保乳手术患者、31%的乳房切除术患者和 22%的两种手术都做的患者来说，“快速做出决定”比“彻底研究所有选择”更重要。几乎所有女性都使用了其他一些来源的信息来研究治疗选择。在没有进一步研究的情况下仅依赖外科医生建议的保乳手术患者和乳房切除术患者，报告“完全了解”的可能性显著降低（比值比 0.6；95%CI 0.4 至 0.9；p<0.02）。
许多接受乳腺癌手术的女性对自己的手术选择并不完全了解。这部分是由于患者的一种错误的紧迫感，也许是由于信息收集不足或方向错误。外科医生必须更好地履行全面告知患者治疗选择的责任。
