a Lombardi Comprehensive Cancer Center , Georgetown University Medical Center , Washington , DC , USA.
b John Theurer Cancer Center , Hackensack University Medical Center , Hackensack , New Jersey , USA.
J Health Commun. 2018;23(7):679-686. doi: 10.1080/10810730.2018.1506836. Epub 2018 Aug 21.
Thousands of women with early-stage breast cancer receive gene-expression profile (GEP) tests to guide chemotherapy decisions. However, many patients report a poor understanding of how their test results inform treatment decision-making. We applied models of patient-centered communication and informed decision-making to assess which variables oncologists' perceive as most influential to effective communication with their patients about GEP results and intervention modalities and approaches that could support more effective conversations about treatment decisions in routine clinical care. Medical oncologists who were part of a practice group in the mid-Atlantic US completed an online, cross-sectional survey in 2016. These data were merged with de-identified electronic patient and practice data. Of the 83 oncologists contacted, 29 completed the survey (35% response rate, representing 52% of the test-eligible patients in the practice network). There were no significant differences between survey responders and nonresponders. Oncologists reported patient-related variables as most influential, including performance status (65.5%), pretesting preferences for chemotherapy (55.2%), and comprehension of complex test results (55.2%). Oncologists endorsed their experience with testing (58.6%) and their own confidence in using the test results (48.3%) as influential as well. They indicated that a clinical decision support tool incorporating patient comorbidities, age, and potential benefits from chemotherapy would support their own practice and that they could share these results and other means of communication support using print materials (79.3%) with their patients in clinic (72.4%). These preferred intervention characteristics could be integrated into routine care, ultimately facilitating more effective communication about genomic testing (such as GEP) and its role in treatment selection.
数千名早期乳腺癌女性接受基因表达谱（GEP）检测以指导化疗决策。然而，许多患者表示对其检测结果如何影响治疗决策的理解较差。我们应用以患者为中心的沟通和知情决策模型，评估肿瘤医生认为哪些变量对其与患者就 GEP 结果和干预方式进行有效沟通最具影响力，以及哪些方法可以支持在常规临床护理中就治疗决策进行更有效的沟通。2016 年，美国中大西洋地区的一个实践小组的肿瘤医生完成了一项在线横断面调查。这些数据与匿名电子患者和实践数据合并。在联系的 83 名肿瘤医生中，有 29 名完成了调查（响应率为 35%，代表实践网络中符合检测条件的患者的 52%）。调查的响应者和非响应者之间没有显著差异。肿瘤医生报告说，患者相关的变量最具影响力，包括表现状态（65.5%）、化疗前的偏好（55.2%）和对复杂检测结果的理解（55.2%）。肿瘤医生也表示他们的检测经验（58.6%）和他们自己对使用检测结果的信心（48.3%）同样具有影响力。他们表示，一个包含患者合并症、年龄和化疗潜在获益的临床决策支持工具将支持他们自己的实践，他们可以在诊所中与患者分享这些结果和其他沟通支持手段，如打印材料（79.3%）。这些首选的干预特征可以整合到常规护理中，最终促进更有效地沟通关于基因组检测（如 GEP）及其在治疗选择中的作用。
