1 Division of Neurotology and Skull Base Surgery, University of California, Irvine, Irvine, California, USA.
2 Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA.
Otolaryngol Head Neck Surg. 2018 May;158(5):912-916. doi: 10.1177/0194599818756852. Epub 2018 Feb 13.
Objective To assess the decision-making process of patients with vestibular schwannoma (VS). Study Design Patients with VS completed a voluntary survey over a 3-month period. Setting Surveys were distributed online through email, Facebook, and member website. Subjects and Methods All patients had a diagnosis of VS and were members of the Acoustic Neuroma Association (ANA). A total of 789 patients completed the online survey. Results Of the 789 participants, 474 (60%) cited physician recommendation as a significant influential factor in deciding treatment. In our sample, 629 (80%) saw multiple VS specialists and 410 (52%) sought second opinions within the same specialty. Of those who received multiple consults, 242 (59%) of patients reported receiving different opinions regarding treatment. Those undergoing observation spent significantly less time with the physician (41 minutes) compared to surgery (68 minutes) and radiation (60 minutes) patients ( P < .001). A total of 32 (4%) patients stated the physician alone made the decision for treatment, and 29 (4%) felt they did not understand all possible treatment options before final decision was made. Of the 414 patients who underwent surgery, 66 (16%) felt they were pressured by the surgeon to choose surgical treatment. Conclusion Deciding on a proper VS treatment for patients can be complicated and dependent on numerous clinical and individual factors. It is clear that many patients find it important to seek second opinions from other specialties. Moreover, second opinions within the same specialty are common, and the number of neurotologists consulted correlated with higher decision satisfaction.
目的 评估听神经瘤（VS）患者的决策过程。
研究设计 患者在 3 个月的时间内完成了一项自愿调查。
设置 通过电子邮件、Facebook 和会员网站在线分发调查。
受试者和方法 所有患者均被诊断为 VS，且均为听神经瘤协会（ANA）的成员。共有 789 名患者完成了在线调查。
结果 在 789 名参与者中，有 474 名（60%）将医生的建议视为决定治疗的重要影响因素。在我们的样本中，有 629 名（80%）患者看了多个 VS 专家，410 名（52%）患者在同一专业范围内寻求了第二意见。在接受多次咨询的患者中，有 242 名（59%）患者报告称治疗方面的意见不同。接受观察治疗的患者与接受手术（68 分钟）和放疗（60 分钟）的患者相比，与医生的就诊时间明显缩短（41 分钟）（P<0.001）。共有 32 名（4%）患者表示医生独自做出了治疗决定，有 29 名（4%）患者表示在最终决定做出之前，他们不了解所有可能的治疗方案。在接受手术的 414 名患者中，有 66 名（16%）患者感到他们受到了外科医生的压力，被迫选择手术治疗。
结论 为患者选择合适的 VS 治疗方案可能很复杂，取决于许多临床和个体因素。很明显，许多患者认为从其他专业寻求第二意见很重要。此外，在同一专业内寻求第二意见很常见，咨询的神经科医生数量与更高的决策满意度相关。
