Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
Eur J Cancer Care (Engl). 2019 May;28(3):e13092. doi: 10.1111/ecc.13092. Epub 2019 May 9.
Current follow-up arrangements for breast cancer do not optimally meet the needs of individual patients. We therefore reviewed the evidence on preferences and patient involvement in decisions about breast cancer follow-up to explore the potential for personalised care.
Studies published between 2008 and 2017 were extracted from MEDLINE, PsycINFO and EMBASE. We then identified decision categories related to content and form of follow-up. Criteria for preference sensitiveness and patient involvement were compiled and applied to determine the extent to which decisions were sensitive to patient preferences and patients were involved.
Forty-one studies were included in the full-text analysis. Four decision categories were identified: "surveillance for recurrent/secondary breast cancer; consultations for physical and psychosocial effects; recurrence-risk reduction by anti-hormonal treatment; and improving quality of life after breast cancer." There was little evidence that physicians treated decisions about anti-hormonal treatment, menopausal symptoms, and follow-up consultations as sensitive to patient preferences. Decisions about breast reconstruction were considered as very sensitive to patient preferences, and patients were usually involved.
Patients are currently not involved in all decisions that affect them during follow-up, indicating a need for improvements. Personalised follow-up care could improve resource allocation and the value of care for patients.
目前的乳腺癌随访安排并不能很好地满足个体患者的需求。因此，我们回顾了有关乳腺癌随访偏好和患者参与决策的证据，以探讨个性化护理的潜力。
从 MEDLINE、PsycINFO 和 EMBASE 中提取了 2008 年至 2017 年期间发表的研究。然后，我们确定了与随访内容和形式相关的决策类别。编制了偏好敏感性和患者参与的标准，并应用这些标准来确定决策对患者偏好的敏感程度以及患者的参与程度。
共有 41 项研究纳入全文分析。确定了四个决策类别：“监测复发性/继发性乳腺癌；咨询身体和心理社会影响；通过抗激素治疗降低复发风险；改善乳腺癌后生活质量”。几乎没有证据表明医生将抗激素治疗、绝经症状和随访咨询的决策视为对患者偏好敏感。乳房重建的决策被认为非常敏感，患者通常会参与。
目前，患者并未参与随访期间影响他们的所有决策，这表明需要改进。个性化的随访护理可以改善资源分配和患者护理的价值。
