Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA; Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Patient Educ Couns. 2021 Jan;104(1):33-39. doi: 10.1016/j.pec.2020.03.001. Epub 2020 Mar 3.
Next generation sequencing (NGS) may aid in tumor classification and treatment. Barriers to shared decision-making may influence use of NGS. We examined, from oncologists' perspectives, whether barriers to involving patients/families in decision-making were associated with NGS use.
Using data from the first national survey of medical oncologists' perspectives on precision medicine (N = 1281), we approached our analyses in two phases. Bivariate analyses initially evaluated associations between barriers to involving patients/families in deciding to use NGS and provider- and organizational-level characteristics. Modified Poisson regressions then examined associations between patient/family barriers and NGS use.
Approximately 59 % of oncologists reported at least one barrier to involving patients/families in decision-making regarding NGS use. Those reporting patient/family barriers tended to have fewer genomic resources at their practices, to be in rural or suburban areas, and to have a higher proportion of Medicaid patients. However, these barriers were not associated with NGS use.
Oncologists encounter barriers to involving patients/families in NGS testing decisions. Organizational barriers may also potentially play a role in testing decisions.
To foster patient-centered care, strategies to support patient involvement in genomic testing decisions are needed, particularly among practices in low-resource settings.
下一代测序（NGS）可能有助于肿瘤分类和治疗。共享决策的障碍可能会影响 NGS 的使用。我们从肿瘤学家的角度研究了，是否存在使患者/家属参与决策的障碍与 NGS 的使用有关。
利用来自医学肿瘤学家对精准医学的首次全国性调查（N=1281）的数据，我们分两个阶段进行分析。在单变量分析中，首先评估了参与决定使用 NGS 的患者/家属的障碍与提供者和组织层面特征之间的关联。然后，采用改良泊松回归分析，评估了患者/家庭障碍与 NGS 使用之间的关联。
约 59%的肿瘤学家报告说，在决定使用 NGS 时，至少存在一个使患者/家属参与决策的障碍。那些报告存在患者/家庭障碍的医生往往在他们的实践中拥有较少的基因组资源，他们的工作地点位于农村或郊区，而且 Medicaid 患者的比例较高。然而，这些障碍与 NGS 的使用无关。
肿瘤学家在涉及患者/家属参与 NGS 检测决策时会遇到障碍。组织障碍也可能在检测决策中发挥作用。
为了促进以患者为中心的护理，需要制定支持患者参与基因检测决策的策略，特别是在资源匮乏的环境中的实践中。
