Lifford Kate J, Edwards Adrian, Burton Maria, Harder Helena, Armitage Fiona, Morgan Jenna L, Caldon Lisa, Balachandran Kirsty, Ring Alistair, Collins Karen, Reed Malcolm, Wyld Lynda, Brain Kate
Division of Population Medicine, Cardiff University, Cardiff, UK,
Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
Patient Prefer Adherence. 2019 Jan 14;13:131-143. doi: 10.2147/PPA.S178347. eCollection 2019.
Around one-third of breast cancers diagnosed every year in the UK are in women aged ≥70 years. However, there are currently no decision support interventions (DESIs) for older women who have a choice between primary endocrine therapy and surgery followed by adjuvant endocrine therapy (surgery+endocrine therapy), or who can choose whether or not to have chemotherapy following surgery. There is also little evidence-based guidance specifically on the management of these older patients. A large UK cohort study is currently underway to address this lack of evidence and to develop two DESIs to facilitate shared decision-making with older women about breast cancer treatments. Here, we present the development and initial testing of these two DESIs.
An initial prototype DESI was developed for the choice of primary endocrine therapy or surgery+endocrine therapy. Semi-structured interviews with healthy volunteers and patients explored DESI acceptability, usability, and utility. A framework approach was used for analysis. A second DESI for the choice of having chemotherapy or not was subsequently developed based on more focused development and testing.
Participants (n=22, aged 75-94 years, 64% healthy volunteers, 36% patients) found the primary endocrine therapy /surgery+endocrine therapy DESI acceptable, and contributed to improved wording and illustrations to address misunderstandings. The chemotherapy DESI (tested with 14 participants, aged 70-87 years, 57% healthy volunteers, 43% patients) was mostly understandable, however, suggestions for rewording sections were made. Most participants considered the DESIs helpful, but highlighted the importance of complementary discussions with clinicians.
It was possible to use a template DESI to efficiently create a second prototype for a different treatment option (chemotherapy). Both DESIs were acceptable and considered helpful to support/augment consultations. Development of acceptable additional DESIs for similar target populations using simplified methods may be an efficient way to develop future DESIs. Further research is needed to test the effectiveness of the DESIs.
在英国，每年诊断出的乳腺癌患者中约有三分之一是70岁及以上的女性。然而，目前对于那些在原发性内分泌治疗和手术加辅助内分泌治疗（手术 + 内分泌治疗）之间进行选择，或者在手术后是否选择化疗的老年女性，尚无决策支持干预措施（DESIs）。也几乎没有专门针对这些老年患者管理的循证指南。目前英国正在进行一项大型队列研究，以解决这一证据不足的问题，并开发两种DESIs，以促进与老年女性就乳腺癌治疗进行共同决策。在此，我们介绍这两种DESIs的开发和初步测试情况。
为原发性内分泌治疗或手术 + 内分泌治疗的选择开发了一个初始原型DESI。对健康志愿者和患者进行半结构化访谈，探讨DESI的可接受性、可用性和实用性。采用框架分析法进行分析。随后，基于更有针对性的开发和测试，开发了用于选择是否进行化疗的第二种DESI。
参与者（n = 22，年龄75 - 94岁，64%为健康志愿者，3,6%为患者）认为原发性内分泌治疗/手术 + 内分泌治疗的DESI是可接受的，并对改进措辞和插图以解决误解做出了贡献。化疗DESI（对14名参与者进行了测试，年龄70 - 87岁，57%为健康志愿者，43%为患者）大多易于理解，不过有人提出了部分措辞修改建议。大多数参与者认为DESIs有帮助，但强调了与临床医生进行补充讨论的重要性。
使用模板DESI能够有效地为不同的治疗选择（化疗）创建第二个原型。两种DESIs均可接受，并被认为有助于支持/加强咨询。采用简化方法为类似目标人群开发可接受的其他DESIs可能是未来开发DESIs的一种有效方式。需要进一步研究来测试DESIs的有效性。
