Clarke A, Paraskeva N, White P, Tollow P, Hansen E, Harcourt D
Centre for Appearance Research, University of the West of England, Frenchay Campus, Cold Harbour Lane, Bristol, BS16 1QY, UK.
Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
J Cancer Educ. 2021 Jun;36(3):508-518. doi: 10.1007/s13187-019-01656-6.
Studies have found varying levels of satisfaction after breast reconstruction surgery with a substantial group of patients reporting some level of regret about their decision. The variable outcomes reported by women undergoing breast reconstruction surgery suggest a role for improved pre-operative communication and shared decision-making (SDM) between patient and health professional. Pragmatic approaches such as decision aids have been evaluated, but the aim of the Patient Expectations and Goals Assisting Shared Understanding of Surgery (PEGASUS) intervention is to facilitate closer interaction between the patient and clinical team. PEGASUS is a standardised two-stage process, in which patients' goals are first elicited, ranked in importance and recorded before being used to frame discussion and decision-making with the surgeon managing care. Following the Medical Research Council (MRC) model, feasibility and acceptability studies have already been reported and a 4-year multicentre randomised controlled trial of 180 participants is underway, (completion 2020). This paper therefore focuses on the design of the intervention itself, in line with recent advice that interventions, in comparison with evaluations, commonly lack a theoretical base and are often under reported. We report a retrospective application of the Capability, Opportunity, Motivation-Behaviour (COM-B) model to provide explicit detail of each step in the intervention design. This is intended to facilitate replication by other clinicians and to provide systematic guidance for others wishing to develop PEGASUS as a strategy for implementing SDM in other clinical populations. Trial Registration: ISRCTN 18000391 (DOI 10.1186/ISRCTN18000391) 27/01/2016.
研究发现，乳房重建手术后患者的满意度各不相同，相当一部分患者对自己的决定表示一定程度的后悔。接受乳房重建手术的女性所报告的不同结果表明，改善患者与医疗专业人员之间的术前沟通和共同决策（SDM）具有重要作用。诸如决策辅助工具等实用方法已得到评估，但患者期望与目标辅助手术共同理解（PEGASUS）干预措施的目的是促进患者与临床团队之间更密切的互动。PEGASUS是一个标准化的两阶段过程，首先引出患者的目标，按重要性排序并记录下来，然后用于与负责护理的外科医生进行讨论和决策。遵循医学研究理事会（MRC）模型，已经报告了可行性和可接受性研究，一项针对180名参与者的为期4年的多中心随机对照试验正在进行中（预计2020年完成）。因此，本文重点关注干预措施本身的设计，这与最近的建议一致，即与评估相比，干预措施通常缺乏理论基础且报告不足。我们报告了能力、机会、动机—行为（COM-B）模型的回顾性应用，以详细说明干预设计中每个步骤的具体细节。这旨在便于其他临床医生进行复制，并为希望将PEGASUS开发为在其他临床人群中实施SDM策略的其他人提供系统指导。试验注册：ISRCTN 18000391（DOI 10.1186/ISRCTN18000391）2016年1月27日。
