Department of Cardio-thoracic Surgery, Erasmus-MC, Room Bd-577, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Radiation Oncology, Erasmus-MC-Cancer Institute, Rotterdam, The Netherlands.
BMC Cancer. 2018 Jan 15;18(1):79. doi: 10.1186/s12885-018-3986-5.
The objective of this study is to investigate the role and experience of early stage non-small cell lung cancer (NSCLC) patient in decision making process concerning treatment selection in the current clinical practice.
Stage I-II NSCLC patients (surgery 55 patients, SBRT 29 patients, median age 68) were included in this prospective study and completed a questionnaire that explored: (1) perceived patient knowledge of the advantages and disadvantages of the treatment options, (2) experience with current clinical decision making, and (3) the information that the patient reported to have received from their treating physician. This was assessed by multiple-choice, 1-5 Likert Scale, and open questions. The Decisional Conflict Scale was used to assess the decisional conflict. Health related quality of life (HRQoL) was measured with SF-36 questionnaire.
In 19% of patients, there was self-reported perceived lack of knowledge about the advantages and disadvantages of the treatment options. Seventy-four percent of patients felt that they were sufficiently involved in decision-making by their physician, and 81% found it important to be involved in decision making. Forty percent experienced decisional conflict, and one-in-five patients to such an extent that it made them feel unsure about the decision. Subscores with regard to feeling uninformed and on uncertainty, contributed the most to decisional conflict, as 36% felt uninformed and 17% of patients were not satisfied with their decision. HRQoL was not influenced by patient experience with decision-making or patient preferences for shared decision making.
Dutch early-stage NSCLC patients find it important to be involved in treatment decision making. Yet a substantial proportion experiences decisional conflict and feels uninformed. Better patient information and/or involvement in treatment-decision-making is needed in order to improve patient knowledge and hopefully reduce decisional conflict.
本研究旨在探讨当前临床实践中早期非小细胞肺癌（NSCLC）患者在治疗选择决策过程中的作用和体验。
本前瞻性研究纳入了 I 期-II 期 NSCLC 患者（手术治疗 55 例，SBRT 治疗 29 例，中位年龄 68 岁），并完成了一份调查问卷，其中包括：（1）患者对治疗方案优缺点的认知；（2）对当前临床决策制定的体验；（3）患者报告从治疗医生那里获得的信息。这些问题采用多项选择、1-5 级李克特量表和开放性问题进行评估。采用决策冲突量表评估决策冲突。采用 SF-36 问卷评估健康相关生活质量（HRQoL）。
19%的患者自述对治疗方案的优缺点缺乏了解。74%的患者认为他们在很大程度上参与了医生的决策制定，81%的患者认为参与决策很重要。40%的患者经历了决策冲突，五分之一的患者感到非常困惑。在决策冲突方面，感觉信息不足和不确定感的得分最高，分别有 36%的患者感到信息不足，17%的患者对自己的决策不满意。HRQoL 不受患者对决策的体验或对共同决策的偏好的影响。
荷兰早期 NSCLC 患者认为参与治疗决策很重要。然而，相当一部分患者经历了决策冲突并感到信息不足。需要改善患者信息和/或参与治疗决策制定，以提高患者的知识水平，并希望减少决策冲突。
