告知对接受即刻乳房重建的乳腺癌患者的影响。
The effect of being informed on receiving immediate breast reconstruction in breast cancer patients.
机构信息
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands; Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 215, 7500 AE Enschede, The Netherlands.
Department of Surgery, Albinusdreef 2, 2333 ZA, Leiden University Medical Centre, Leiden, The Netherlands; Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands.
出版信息
Eur J Surg Oncol. 2018 May;44(5):717-724. doi: 10.1016/j.ejso.2018.01.226. Epub 2018 Feb 2.
INTRODUCTION
In previous research from the NABON breast cancer audit, observed hospital variation in immediate breast reconstruction (IBR) rates in the Netherlands could not be fully explained by tumour, patient, and hospital factors. The process of information provision and decision-making may also contribute to the observed variation; the objective of the current study was to give insight in the underlying decision-making process for IBR and to determine the effect of being informed about IBR on receiving IBR.
METHODS
A total of 502 patients with IBR and 716 without IBR treated at twenty-nine hospitals were invited to complete an online questionnaire on obtained information and decision-making regarding IBR. The effect of being informed about IBR on receiving IBR was determined by logistic regression analysis.
RESULTS
Responses from five hundred and ten patients (n = 229 IBR, n = 281 without IBR) were analysed. Patients with IBR compared to patients without reconstruction showed a difference in patient, tumour, treatment (including radiotherapy), and hospital characteristics. Patients with IBR were more often informed about IBR as a treatment option (99% vs 73%), they discussed (dis)advantages more often with their physician (86% vs 68%), and they were more often involved in shared decision-making (91% vs 67%) compared to patients without IBR. Multivariate logistic regression analysis, corrected for confounders, showed that being informed about IBR increased the odds for receiving IBR fourteen times (p < 0.001).
CONCLUSIONS
The positive effect of being informed about IBR on receiving IBR stresses the importance of treatment information in the decision-making process for IBR.
简介
在 NABON 乳腺癌审核的先前研究中，观察到荷兰即时乳房重建（IBR）率的医院间差异不能完全用肿瘤、患者和医院因素来解释。信息提供和决策过程也可能导致观察到的差异；本研究的目的是深入了解 IBR 决策过程，并确定接受 IBR 的IBR 信息提供的效果。
方法
共邀请 29 家医院的 502 名接受 IBR 和 716 名未接受 IBR 的患者完成了一份关于 IBR 获得信息和决策的在线问卷。通过逻辑回归分析确定接受 IBR 信息对接受 IBR 的影响。
结果
对 510 名患者（n=229 IBR，n=281 未接受 IBR）的反应进行了分析。与未接受重建的患者相比，接受 IBR 的患者在患者、肿瘤、治疗（包括放疗）和医院特征方面存在差异。接受 IBR 的患者更经常被告知 IBR 是一种治疗选择（99%对 73%），他们更经常与医生讨论（不）利（86%对 68%），并且更经常参与共同决策（91%对 67%）与未接受 IBR 的患者相比。多变量逻辑回归分析，校正混杂因素后，结果表明，接受 IBR 信息使接受 IBR 的几率增加了 14 倍（p<0.001）。
结论
接受 IBR 信息对接受 IBR 的积极影响强调了治疗信息在 IBR 决策过程中的重要性。
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