Datta Soumitra S, Ghosal Niladri, Daruvala Rhea, Chakraborty Santam, Shrimali Raj Kumar, van Zanten Chantalle, Parry Joe, Agrawal Sanjit, Atreya Shrikant, Sinha Subir, Chatterjee Sanjoy, Gollins Simon
Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata 700160, India.
UCL EGA Institute for Women's Health, University College London, London WC1E 6BT, UK.
Ecancermedicalscience. 2019 Mar 28;13:913. doi: 10.3332/ecancer.2019.913. eCollection 2019.
Medical decisions made by oncology clinicians have serious implications, even when made collaboratively with the patient. Clinicians often use the Eastern Clinical Oncology Group (ECOG) performance status (PS) scores to help them make treatment-related decisions.
The current study explores the variability of the ECOG score when applied to 12 predetermined specially designed clinical case vignettes presented to a group of oncology clinicians ( = 72). The quantitative analysis included evaluation of variability of ECOG PS scores and exploration of rater and patient-related factors which may influence the final ECOG rating. In-depth interviews were conducted with oncology clinicians to ascertain factors that they felt were important while making treatment-related decisions. Basic and global themes were generated following qualitative data analysis.
Quantitative results showed that there was poor agreement in ECOG rating between raters. Overall concordance with the gold standard rating ranged between 19.4% and 56.9% for the vignettes. Moreover, patients deemed to have socially desirable qualities ( < 0.004) were rated to have better PS and women patients ( < 0.004) to have worse PS. Clinicians having international work experience had increased concordance with ECOG PS rating. Qualitative results showed that 'perceived socio-economic background of the patient', 'age of the patient', 'patient's and family's preferences' and 'past treatment response' were the major themes highlighted by respondents that influenced the treatment-related decisions made by clinicians.
There is considerable variability in ECOG PS determined by clinicians. Decision-making in oncology is complex, multifactorial and is influenced by rater and patient-related factors.
肿瘤临床医生做出的医疗决策具有重大影响，即便这些决策是与患者共同做出的。临床医生经常使用东部肿瘤协作组（ECOG）体能状态（PS）评分来辅助他们做出与治疗相关的决策。
本研究探讨了ECOG评分应用于向一组肿瘤临床医生（n = 72）呈现的12个预先设计好的特定临床病例 vignette 时的变异性。定量分析包括评估ECOG PS评分的变异性，以及探究可能影响最终ECOG评级的评估者和患者相关因素。对肿瘤临床医生进行了深入访谈，以确定他们认为在做出与治疗相关的决策时重要的因素。定性数据分析后生成了基本主题和总体主题。
定量结果显示，评估者之间在ECOG评级上的一致性较差。 vignette与金标准评级的总体一致性在19.4%至56.9%之间。此外，被认为具有社会期望特质的患者（P < 0.004）被评定为具有更好的PS，而女性患者（P < 0.004）的PS则较差。具有国际工作经验的临床医生与ECOG PS评级的一致性更高。定性结果表明，“患者的社会经济背景认知”、“患者年龄”、“患者及其家属的偏好”和“既往治疗反应”是受访者强调的影响临床医生做出与治疗相关决策的主要主题。
临床医生确定的ECOG PS存在相当大的变异性。肿瘤学中的决策是复杂的、多因素的，并且受到评估者和患者相关因素的影响。
