Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
Breast Cancer Res Treat. 2018 Oct;171(3):545-564. doi: 10.1007/s10549-018-4865-0. Epub 2018 Jul 4.
Older women (≥ 70 years old) with breast cancer undergo different treatments than young women. Studies have examined factors that influence this disparity, but synthesized patient-reported data are lacking in the literature. This study aims to identify, appraise, and synthesize the existing qualitative evidence on patient-reported factors influencing older women's decision to accept or decline breast cancer treatment.
A systematic review was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA) principles. Medline, Embase, CINAHL, and PsycINFO were searched for qualitative studies describing patient-reported factors influencing the decision-making process of older women (≥ 70 years old) with non-metastatic invasive breast cancer. Quality was assessed using the Standards for Reporting Qualitative Research (SRQR) criteria. Common ideas were coded, thematically organized, and synthesized within a theoretical framework.
Of 5998 studies identified, 10 met eligibility criteria. The median SRQR total score was 13.04 (IQR 12.84-13.81). The studies represented a range of cancer treatments; most of the studies focused on surgery and primary endocrine therapy. Our data show that the most common patient-reported factors in the decision-making process included treatment characteristics, personal goals/beliefs, patient characteristics, physician's recommendation, and personal/family experience. These factors led the patient to either accept or decline treatment, and were not consistent across all studies included. Studies used different interview guides, which may have affected these results.
This systematic review highlights the complexity of factors that influence an older woman's treatment decision-making process. Acknowledging and addressing these factors may improve discussions about treatment choices between older women and their health care providers, and encourage maximization of a patient-centered approach.
患有乳腺癌的老年女性（≥70 岁）接受的治疗与年轻女性不同。已有研究探讨了影响这种差异的因素，但文献中缺乏患者报告的综合数据。本研究旨在确定、评估和综合现有关于影响老年女性接受或拒绝乳腺癌治疗决策的患者报告因素的定性证据。
根据系统评价和荟萃分析报告规范（PRISMA）原则进行系统综述。检索 Medline、Embase、CINAHL 和 PsycINFO，以获取描述影响≥70 岁患有非转移性浸润性乳腺癌的老年女性决策过程的患者报告因素的定性研究。使用标准报告定性研究（SRQR）标准评估质量。对常见想法进行编码、主题组织，并在理论框架内进行综合。
在 5998 项研究中，有 10 项符合入选标准。SRQR 总分中位数为 13.04（IQR 12.84-13.81）。这些研究代表了一系列癌症治疗方法；大多数研究集中在手术和原发性内分泌治疗上。我们的数据表明，决策过程中最常见的患者报告因素包括治疗特征、个人目标/信念、患者特征、医生建议和个人/家庭经验。这些因素导致患者接受或拒绝治疗，并且在所有纳入的研究中并不一致。研究使用了不同的访谈指南，这可能影响了这些结果。
本系统综述强调了影响老年女性治疗决策过程的因素的复杂性。承认和解决这些因素可能会改善老年女性及其医疗保健提供者之间关于治疗选择的讨论，并鼓励最大限度地采用以患者为中心的方法。
