Department of Medicine, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2nd Floor, New York City, NY, 10017, USA.
Department of Quantitative Health Sciences, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
J Cancer Surviv. 2020 Aug;14(4):417-423. doi: 10.1007/s11764-020-00860-4. Epub 2020 Feb 10.
Childhood, adolescent, and young adult cancer survivors treated with radiation therapy (RT) may be unaware of their high cardiovascular disease (CVD) risk or how to mitigate it. Tools are needed to improve understanding. We developed and pilot-tested a risk communication tool for shared decision-making with survivors regarding CVD risk reduction with statin therapy. We included quantitative and qualitative arms to further tool development and testing.
The statin risk communication tool was adapted from a previously validated tool. Patients were at increased risk for CVD due to history of chest RT and recruited to usual care and intervention arms. The post-visit survey included Likert-like scales to explore acceptability of the tool, knowledge questions, and a decisional conflict scale. This pilot study used descriptive statistics and was not powered for significance. Semi-structured interviews with intervention arm participants explored shared decision-making processes.
Median participant (n = 46) age was 45. Most intervention patients (22/24, 92%) and 50% (11/22) of controls found statin information acceptable while 31% (7/22) of the control arm selected "not applicable" regarding information acceptability. Most participants were unaware of their personal CVD risk or potential statin side effects. In semi-structured interviews, participants found the tool is helpful to visualize risk and aid conversations.
The risk communication tool was acceptable. Qualitative data suggested the tool improved decisional clarity and comfort.
Poor knowledge of CVD and statins and poor recall of CVD risk conversation suggest a need to continue to optimize conversations regarding cardiovascular risk and statin therapy.
接受放射治疗（RT）的儿童、青少年和年轻成年癌症幸存者可能不知道他们患有心血管疾病（CVD）的风险有多高，或者不知道如何降低这种风险。需要有工具来提高他们的认识。我们开发并试点了一种风险沟通工具，用于与幸存者就使用他汀类药物降低 CVD 风险进行共同决策。我们包括定量和定性两个部分，以进一步开发和测试该工具。
他汀类药物风险沟通工具是从以前验证过的工具改编而来的。由于胸部 RT 的历史，患者存在 CVD 风险增加，并被招募到常规护理和干预组。就诊后的调查包括李克特量表，以探索工具的可接受性、知识问题和决策冲突量表。这项试点研究使用描述性统计，没有进行显著性检验。对干预组参与者进行半结构化访谈，探讨共同决策过程。
中位参与者（n=46）年龄为 45 岁。大多数干预组患者（22/24，92%）和 50%（11/22）的对照组认为他汀类药物信息可以接受，而 31%（7/22）的对照组认为信息可接受性“不适用”。大多数参与者不知道自己的个人 CVD 风险或潜在的他汀类药物副作用。在半结构化访谈中，参与者发现该工具有助于形象化风险并辅助对话。
风险沟通工具是可以接受的。定性数据表明，该工具提高了决策的清晰度和舒适度。
对 CVD 和他汀类药物的知识不足以及对 CVD 风险对话的记忆不佳表明，需要继续优化有关心血管风险和他汀类药物治疗的对话。
