目标与不良反应：患者与提供者之间的一致率。
Goals and Adverse Effects: Rate of Concordance Between Patients and Providers.
机构信息
Wake Forest Baptist Medical Center, Winston-Salem, NC.
Wake Forest School of Medicine, Winston-Salem, NC.
出版信息
J Oncol Pract. 2019 Sep;15(9):e798-e806. doi: 10.1200/JOP.19.00015. Epub 2019 Jul 29.
PURPOSE
Adequate understanding of the goals and adverse effects of cancer treatment has important implications for patients' decision making, expectations, and mood. This study sought to identify the degree to which patients and clinicians agreed upon the goals and adverse effects of treatment (ie, concordance).
METHODS
Patients completed a demographic questionnaire, the National Comprehensive Cancer Network Distress Thermometer, the Medical Outcomes Study Social Support Survey, the Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-General questionnaire, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being questionnaire, and a 13-item questionnaire about the goals and adverse effects of treatment. Providers completed a 12-item questionnaire.
RESULTS
One hundred patients (51 female) and 34 providers participated (questionnaire return rate mean difference, 5 days; SD, 16 days). Patient and provider dyads agreed 61% of the time regarding the intent of treatment. In cases of nonagreement, 36% of patients reported more optimistic therapy goals compared to providers. Patients and providers agreed 69% of the time regarding the patient's acknowledgement and understanding of adverse effects. Patients who reported an understanding of likely adverse effects endorsed significantly lower distress scores (mean, 2.5) than those who endorsed not understanding associated adverse effects (mean, 4.1; = .008).
CONCLUSION
Timely data capturing of patient-provider dyadic ratings is feasible. A significant discrepancy exists between a substantial percentage of patients' and providers' views of the intent and adverse effects of treatment. Patients were almost always more optimistic about the intent of treatment. Higher rates of distress were noted in cases of discordance. Providers may benefit from conversational feedback from patients as well as other integrated feedback systems to inform them about patient understanding.
目的
充分了解癌症治疗的目标和不良反应对患者的决策、期望和情绪有重要影响。本研究旨在确定患者和临床医生在治疗目标和不良反应方面的一致性程度。
方法
患者完成了一份人口统计学问卷、国家综合癌症网络痛苦温度计、医疗结果研究社会支持调查、慢性病治疗功能评估-治疗满意度-一般问卷、慢性病治疗功能评估-精神健康问卷，以及一份关于治疗目标和不良反应的 13 项问卷。医务人员完成了一份 12 项的问卷。
结果
共有 100 名患者（51 名女性）和 34 名医务人员参与了研究（问卷回复率平均差异为 5 天；SD 为 16 天）。患者和医务人员在治疗意图上的一致性为 61%。在不一致的情况下，36%的患者报告的治疗目标比医务人员更乐观。在患者对不良反应的认知和理解方面，患者和医务人员的一致性为 69%。报告理解可能发生的不良反应的患者的焦虑评分显著低于报告不理解相关不良反应的患者（平均 2.5 分比 4.1 分；=.008）。
结论
及时捕捉患者-医务人员对治疗意图和不良反应的看法是可行的。患者和医务人员对治疗意图和不良反应的看法存在显著差异。患者对治疗意图几乎总是更乐观。在不一致的情况下，焦虑评分更高。医务人员可能受益于来自患者的对话反馈以及其他集成反馈系统，以告知他们患者的理解情况。
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