Department of Urology, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022, GC, Tilburg, the Netherlands; Department of Urology, Erasmus University Medical Center, the Netherlands.
Department of Urology, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022, GC, Tilburg, the Netherlands.
J Geriatr Oncol. 2019 Jul;10(4):653-658. doi: 10.1016/j.jgo.2018.12.003. Epub 2019 Jan 11.
To evaluate perspectives of the multidisciplinary team concerning shared decision-making (SDM) in treatment decisions for older patients with metastatic castration-resistant prostate cancer (mCRPC).
A survey among Dutch healthcare providers was conducted to assess healthcare providers' perspectives on patient involvement in decision-making and the value of a decision aid (DA) in the decision-making process. Treatment recommendations were assessed using hypothetical cases in which providers were asked to evaluate their likelihood of pursuing listed treatment options.
In total, 170 Dutch healthcare providers, including 82 urologists, 31 oncologists, and 57 oncology nurses completed the survey. Sixty-two percent of urologists, 65% of oncologists, and 51% of oncology nurses found that mCRPC patients take a passive role in decision-making and delegate treatment decisions to doctors due to advanced age (p = .45). Yet, 70% of urologists, 71% of oncologists, and 63% of oncology nurses agreed that mCRPC patients should be always involved in decision-making (p = .91). Fifty-two percent of urologists and 55% of oncologists stated that they are inadequately trained to apply SDM in clinical practice. Conversely, only 20% of oncology nurses believed that oncology nurses are inadequately trained. Fifty-four percent of all providers considered a DA suitable to support these patients and their healthcare providers in the decision-making process. All hypothetical cases showed variation in treatment recommendations among providers, with each of the five treatments ranging from extremely likely to extremely unlikely.
The wide variation of treatment recommendations observed among the multidisciplinary team suggests that mCRPC patients and their healthcare providers may benefit from implementation of informed SDM. Given the perceived passive role of older patients with mCRPC in decision-making, interventions to engage them are needed. With slightly more than half of respondents finding DAs useful to facilitate the decision-making process, development and implementation of a DA would be an interesting field of research.
评估多学科团队对转移性去势抵抗性前列腺癌（mCRPC）老年患者治疗决策中共享决策（SDM）的看法。
对荷兰医疗保健提供者进行了一项调查，以评估医疗保健提供者对患者参与决策的看法以及决策辅助工具（DA）在决策过程中的价值。使用假设病例评估治疗建议，要求提供者评估他们采用列出的治疗方案的可能性。
共有 170 名荷兰医疗保健提供者，包括 82 名泌尿科医生、31 名肿瘤学家和 57 名肿瘤护士，完成了调查。62%的泌尿科医生、65%的肿瘤学家和 51%的肿瘤护士认为，由于年龄较大，mCRPC 患者在决策中采取被动角色，并将治疗决策委托给医生（p=0.45）。然而，70%的泌尿科医生、71%的肿瘤学家和 63%的肿瘤护士认为 mCRPC 患者应始终参与决策（p=0.91）。52%的泌尿科医生和 55%的肿瘤学家表示，他们在临床实践中应用 SDM 的培训不足。相反，只有 20%的肿瘤护士认为肿瘤护士的培训不足。54%的提供者认为 DA 适合支持这些患者及其医疗保健提供者的决策过程。所有假设病例都显示，提供者之间的治疗建议存在差异，五种治疗方法中的每一种都从极有可能到极不可能。
多学科团队观察到的治疗建议广泛差异表明，mCRPC 患者及其医疗保健提供者可能受益于实施知情的 SDM。鉴于 mCRPC 老年患者在决策中表现出的被动角色，需要采取干预措施来吸引他们。略多于一半的受访者认为 DA 有助于促进决策过程，因此开发和实施 DA 将是一个有趣的研究领域。
