Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
Support Care Cancer. 2021 Jan;29(1):417-425. doi: 10.1007/s00520-020-05498-7. Epub 2020 May 7.
To explore in a sample of adult cancer patients: (1) the relative influence of initiation source, information format and consultation format on preferred approach to life expectancy disclosure using a discrete choice experiment (DCE); and (2) whether patient age, cancer type and perceived prognosis were associated with preferences within the three attributes.
A DCE survey of adult solid tumour and haematological cancer patients. Participants chose between three hypothetical scenarios about life expectancy disclosure consisting of three attributes: initiation source (i.e. doctor versus patient-initiated discussion), information content (i.e. estimate presented as best-worst-typical length of life case scenario versus median survival time) and consultation format (i.e. two 20-min versus one 40-min consultation). Respondents selected their most preferred scenario within each question.
Three hundred and two patients completed the DCE (78% consent rate). Initiation source was the most influential predictor of patient choice. More preferred a doctor deliver life expectancy information as soon as it is available rather than waiting for the patient to ask (59% vs 41% z = - 7.396, p < 0.01). More patients preferred the two 20-min rather than the one 40-min consultation format (55% vs 45%, z = 4.284, p < 0.01). Information content did not influence choice. Age, cancer type, and patient-perceived prognosis were not associated with preferences.
Healthcare professionals should assess cancer patients' preferences for engaging in life expectancy discussions as soon as they have this information, and ensure patients have adequate time to consider the information they receive, seek additional information and involve others if they wish.
在成年癌症患者样本中探索：（1）采用离散选择实验（DCE），启动源、信息格式和咨询格式对预期寿命披露首选方法的相对影响；（2）患者年龄、癌症类型和感知预后是否与三个属性内的偏好相关。
对成年实体瘤和血液系统癌症患者进行 DCE 调查。参与者在三个假设的预期寿命披露情景之间进行选择，这些情景由三个属性组成：启动源（即医生与患者发起的讨论）、信息内容（即估计呈现为最佳最差典型寿命情况与中位生存时间）和咨询格式（即两次 20 分钟与一次 40 分钟咨询）。受访者在每个问题中选择他们最偏好的方案。
302 名患者完成了 DCE（同意率为 78%）。启动源是预测患者选择的最主要因素。更多的患者希望医生尽快提供预期寿命信息，而不是等待患者询问（59%对 41%，z=-7.396，p<0.01）。更多的患者更喜欢两次 20 分钟而不是一次 40 分钟的咨询格式（55%对 45%，z=4.284，p<0.01）。信息内容并不影响选择。年龄、癌症类型和患者感知的预后与偏好无关。
医疗保健专业人员应该评估癌症患者对尽早参与预期寿命讨论的偏好，并确保患者有足够的时间考虑他们收到的信息，寻求其他信息并在需要时让其他人参与。
