Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands; Department of Surgery, Antoni van Leeuwenhoek-National Cancer Institute, Amsterdam, the Netherlands.
Department of Surgery, Antoni van Leeuwenhoek-National Cancer Institute, Amsterdam, the Netherlands.
Eur J Surg Oncol. 2020 Sep;46(9):1634-1641. doi: 10.1016/j.ejso.2020.04.014. Epub 2020 Apr 15.
Several factors are included in decision making for treatment of patients with locally advanced rectal cancer, including a trade-off between risks and gains of both clinical and functional outcomes. However, it is largely unknown which outcomes are most important to patients and whether this differs between patients and clinicians.
Both clinicians and patients treated for locally advanced rectal cancer were invited to fill out an online questionnaire, including a choice-based conjoint experiment. Participants were presented 14 comparisons of two hypothetical case presentations, characterized by different treatments and outcomes of care (6 attributes) and were asked to select the case with the best outcome at that moment. Hierarchical Bayes Estimation was used to calculate the relative importance (RI) of each of the six attributes.
In total, 94 patients and 128 clinicians completed the questionnaire. For patients, avoiding surgery with permanent stoma was most important (RI 24.4, 95%CI 21.88-26.87) and a 2-year difference in disease-free survival was least important (RI 5.6, 95%CI 4.9-6.2). Clinicians assigned highest importance to avoiding severe and daily worries about cancer recurrence (RI 30.7, 95%CI 29.1-32.4), while this was ranked 4th by patients (RI 17.9, 95%CI 16.5-19.4, p < 0.001).
When confronted with different outcomes within one case description, patients find the duration of disease free survival the least important. In addition, considerable differences were found between the importance assigned by patients and clinicians to clinical and functional outcomes, most notably in avoiding surgery with permanent stoma and worries about recurrence.
治疗局部晚期直肠癌的决策涉及多个因素，包括临床和功能结果风险与获益的权衡。然而，患者认为哪些结果最重要，以及患者和临床医生之间是否存在差异，这些在很大程度上仍不清楚。
我们邀请接受局部晚期直肠癌治疗的患者和临床医生填写在线问卷，其中包括基于选择的联合实验。参与者被展示了 14 种对两种假设病例的描述，这些描述的特点是不同的治疗方法和护理结果（6 个属性），并被要求在那一刻选择结果最好的病例。使用分层贝叶斯估计来计算六个属性中每个属性的相对重要性（RI）。
共有 94 名患者和 128 名临床医生完成了问卷。对于患者而言，避免永久性造口术的手术最为重要（RI 24.4，95%CI 21.88-26.87），2 年无病生存率的差异最不重要（RI 5.6，95%CI 4.9-6.2）。临床医生将避免严重和日常对癌症复发的担忧列为最重要的因素（RI 30.7，95%CI 29.1-32.4），而患者将其排在第 4 位（RI 17.9，95%CI 16.5-19.4，p<0.001）。
当在一个病例描述中面对不同的结果时，患者认为无疾病生存期的长短最不重要。此外，患者和临床医生对临床和功能结果的重要性评估存在显著差异，尤其是在避免永久性造口术和对复发的担忧方面。
