了解患者对早期肺癌治疗决策的价值观和偏好。
Understanding patients' values and preferences regarding early stage lung cancer treatment decision making.
机构信息
Division of Pulmonary and Critical Care Medicine (PCCM), Oregon Health and Science University (OHSU), United States; Health Services Research & Development, Veterans Affairs Portland Health Care System (VAPHCS), United States; Cancer Prevention and Control Program, Knight Cancer Institute, OHSU, United States.
Department of Medical Informatics and Clinical Epidemiology, United States.
出版信息
Lung Cancer. 2019 May;131:47-57. doi: 10.1016/j.lungcan.2019.03.009. Epub 2019 Mar 9.
INTRODUCTION
With advances in treatments among patients with lung cancer, it is increasingly important to understand patients' values and preferences to facilitate shared decision making.
METHODS
Prospective, multicenter study of patients with treated stage I lung cancer. At the time of study participation, participants were 4-6 months posttreatment. Value clarification and discrete choice methods were used to elicit participants' values and treatment preferences regarding stereotactic body radiation therapy (SBRT) and surgical resection using only treatment attributes.
RESULTS
Among 114 participants, mean age was 70 years (Standard Deviation = 7.9), 65% were male, 68 (60%) received SBRT and 46 (40%) received surgery. More participants valued independence and quality of life (QOL) as "most important" compared to survival or cancer recurrence. Most participants (83%) were willing to accept lung cancer treatment with a 2% chance of periprocedural death for only one additional year of life. Participants also valued independence more than additional years of life as most (86%) were unwilling to accept either permanent placement in a nursing home or being limited to a bed/chair for four additional years of life. Surprisingly, treatment discordance was common as 49% of participants preferred the alternative lung cancer treatment than what they received.
CONCLUSIONS
Among participants with early stage lung cancer, maintaining independence and QOL were more highly valued than survival or cancer recurrence. Participants were willing to accept high periprocedural mortality, but not severe deficits affecting QOL when considering treatment. Treatment discordance was common among participants who received SBRT or surgery. Understanding patients' values and preferences regarding treatment decisions is essential to foster shared decision making and ensure treatment plans are consistent with patients' goals. Clinicians need more resources to engage in high quality communication during lung cancer treatment discussions.
简介
随着肺癌治疗方法的进步，了解患者的价值观和偏好以促进共同决策变得越来越重要。
方法
一项针对已接受治疗的 I 期肺癌患者的前瞻性、多中心研究。在参与研究时，参与者在治疗后 4-6 个月。仅使用治疗属性，通过价值澄清和离散选择方法来引出参与者对立体定向体部放射治疗（SBRT）和手术切除的价值和治疗偏好。
结果
在 114 名参与者中，平均年龄为 70 岁（标准差 = 7.9），65%为男性，68 名（60%）接受 SBRT，46 名（40%）接受手术。与生存或癌症复发相比，更多的参与者将独立性和生活质量（QOL）视为“最重要”。大多数参与者（83%）愿意接受肺癌治疗，其围手术期死亡率为 2%，只为多活一年。与多活几年相比，参与者更看重独立性，因为大多数（86%）人不愿意接受永久性入住疗养院或在轮椅或床上限制生活 4 年。令人惊讶的是，治疗不一致很常见，因为 49%的参与者更喜欢另一种肺癌治疗方法。
结论
在早期肺癌患者中，保持独立性和 QOL 比生存或癌症复发更受重视。当考虑治疗时，参与者愿意接受高围手术期死亡率，但不愿意接受严重影响 QOL 的情况。在接受 SBRT 或手术的参与者中，治疗不一致很常见。了解患者对治疗决策的价值观和偏好对于促进共同决策并确保治疗计划与患者的目标一致至关重要。临床医生需要更多资源来进行高质量的沟通，以在肺癌治疗讨论中。
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