National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan.
Eisai Co., Ltd., 4-6-10 Koishikawa, Bunkyo-ku, Tokyo, 112-8088, Japan.
Breast Cancer. 2019 Nov;26(6):799-807. doi: 10.1007/s12282-019-00986-z. Epub 2019 Jun 8.
Although communication between patients with breast cancer and physicians is central to treatment decision-making for patients and the concept of shared decision-making has been increasingly advocated worldwide, little is known about decision-making and perceptions among the population in Japan. Therefore, this cross-sectional study aimed to clarify the status of pharmacotherapy decision-making among patients with breast cancer in Japan and assess factors associated with patient satisfaction with patient-physician communication.
Data for women previously treated with pharmacotherapy agents for breast cancer in Japan were collected in July 2017 using an online survey. Respondents were categorized by their decision-making role (active, shared, passive). Characteristics, decisional conflict level, and satisfaction with communication with their physician at the time of pharmacotherapy selection were stratified by decision-making roles. Stepwise multivariate logistic regression was performed to assess factors associated with satisfaction.
Of 486 women that responded, nearly half played an active decision-making role (48.4%) and 26.0% played a shared role. The lowest decisional conflict and higher satisfaction were observed among those who played a shared role. The highest decisional conflict and lower satisfaction were observed in passive decision-makers. Shared decision-making, a longer consultation time with the physician, and multiple treatment options provided by the physician were significantly associated with satisfaction with communication with the physician.
Our findings suggest that among patients with breast cancer, a shared role in treatment decision-making, longer consultation time at treatment selection, and having multiple treatment options are important for higher patient satisfaction with communication with their physician.
尽管医患沟通是患者治疗决策的核心,并且共享决策的理念在全球范围内得到了越来越多的倡导,但人们对日本人群的决策和看法知之甚少。因此,本横断面研究旨在阐明日本乳腺癌患者的药物治疗决策现状,并评估与患者对医患沟通满意度相关的因素。
2017 年 7 月,通过在线调查收集了日本既往接受过乳腺癌药物治疗的女性患者的数据。根据决策角色(主动、共享、被动)对受访者进行分类。按决策角色分层比较药物治疗选择时的特征、决策冲突水平和与医生沟通的满意度。采用逐步多元逻辑回归评估与满意度相关的因素。
在 486 名应答者中,近一半(48.4%)扮演主动决策角色,26.0%扮演共享决策角色。共享决策角色的决策冲突最低,满意度最高。被动决策者的决策冲突最高,满意度最低。共享决策、与医生的咨询时间较长以及医生提供的多种治疗选择与与医生沟通的满意度显著相关。
我们的研究结果表明,在乳腺癌患者中,共同参与治疗决策、在治疗选择时进行更长时间的咨询以及拥有多种治疗选择对于提高患者对与医生沟通的满意度非常重要。