Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU School of Medicine, New York, NY, USA.
Med Decis Making. 2019 Aug;39(6):642-650. doi: 10.1177/0272989X19862545. Epub 2019 Jul 29.
The objective of this study was to examine whether scores of shared decision-making measures differ when collected shortly after (1 month) or long after (1 year) breast cancer surgical treatment decisions. Longitudinal, multisite survey of breast cancer (BC) patients, with measurements at 1 month and 1 year after surgery at 4 cancer centers. Patients completed the BC Surgery Decision Quality Instrument (used to generate a knowledge score, ratings of goals, and concordance with treatment preferences) and Shared Decision Making (SDM) Process survey at both time points. We tested several hypotheses related to the scores over time, including whether the scores discriminated between sites that did and did not offer formal decision support services. Exploratory analyses examined factors associated with large increases and decreases in scores over time. Across the 4 sites, 229 patients completed both assessments. The mean total knowledge scores (69.2% [SD 16.6%] at 1 month and 69.4% [SD 17.7%] at 1 year, = 0.86), SDM Process scores (2.7 [SD 1.1] 1 month v. 2.7 [SD 1.2] 1 year, = 0.68), and the percentage of patients receiving their preferred treatment (92% at 1 month and 92% at 1 year, = 1.0) were not significantly different over time. The site using formal decision support had significantly higher knowledge and SDM Process scores at 1 month, and only the SDM Process scores remained significantly higher at 1 year. A significant percentage of patients had large changes in their individual knowledge and SDM Process scores, with increases balancing out decreases. For population-level assessments, it is reasonable to survey BC patients up to a year after the decision, greatly increasing feasibility of measurement. For those evaluating decision support interventions, shorter follow-up is more likely to detect an impact on knowledge scores.
这项研究的目的是检验在乳腺癌手术后 1 个月（近期）或 1 年后（远期）收集共享决策措施评分是否存在差异。在 4 家癌症中心进行的乳腺癌（BC）患者的纵向、多站点调查，在手术后 1 个月和 1 年进行测量。患者在两个时间点完成 BC 手术决策质量工具（用于生成知识评分、目标评分和与治疗偏好的一致性）和共享决策（SDM）过程调查。我们测试了几个与随时间变化的评分相关的假设，包括评分是否可以区分是否提供正式决策支持服务的站点。探索性分析检查了与评分随时间大幅增加和减少相关的因素。在 4 个站点中，共有 229 名患者完成了两项评估。平均总知识评分（1 个月时为 69.2%[16.6%]，1 年时为 69.4%[17.7%]， = 0.86）、SDM 过程评分（1 个月时为 2.7[1.1]，1 年时为 2.7[1.2]， = 0.68）和接受首选治疗的患者比例（1 个月时为 92%，1 年时为 92%， = 1.0）在整个时间内没有明显差异。使用正式决策支持的站点在 1 个月时的知识和 SDM 过程评分显著更高，只有 SDM 过程评分在 1 年时仍显著更高。患者个体知识和 SDM 过程评分有显著变化的比例较高，增加的幅度与减少的幅度相当。对于人群水平的评估，在决策后长达 1 年的时间内调查 BC 患者是合理的，这大大提高了测量的可行性。对于评估决策支持干预措施的人来说，较短的随访时间更有可能检测到对知识评分的影响。
