Division of Population Sciences and Inpatient Oncology, Dana-Farber Cancer Institute, Boston, MA.
Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL.
JCO Oncol Pract. 2020 Oct;16(10):e1098-e1111. doi: 10.1200/JOP.19.00608. Epub 2020 May 29.
Medication shortages in US hospitals are ongoing, widespread, and frequently involve antineoplastic and supportive medications used in cancer care. The ways shortages are managed and the ways provider-patient communication takes place are heterogeneous, but the related preferences of oncology patients are undefined. This study sought to qualitatively evaluate patient preferences.
A cross-sectional, semi-structured interview study was conducted from January to June 2019. Participants were adult oncology inpatients who received primary cancer care at the University of Chicago, had undergone treatment within 2 years, and had 1 or more previous hospitalizations during that period. Participants (n = 54) were selected consecutively from alternating hematology and oncology services. The primary outcome was thematic saturation across the domains of awareness of medication shortages, principle preferences regarding decision makers, preferences regarding allocation of therapy drugs, and allocation-related communication.
Thematic saturation was reached after 39 participants completed the study procedures (mean age, 59.6 years [standard deviation, 14.5 years]; men made up 61.5% of the study population [mean age, 24 years]; response rate, 72.0%). In all, 18% of participants were aware of institutional medication shortages. Patients preferred having multiple decision makers for allocating medications in the event of a shortage. A majority of patients named oncologists (100%), ethicists (92%), non-oncology physicians (77%), and pharmacists (64%) as their preferred decision makers. Participants favored allocation of drugs based on their efficacy (normalized weighted average, 1.3), and they also favored prioritizing people who were already receiving treatment (1.8), younger patients (2.0), sicker patients (3.1), and those presenting first for treatment (5.3). Most participants preferred preferred disclosure of supportive care medication shortages (74%) and antineoplastic medication shortages (79%) for equivalent substitutions.
In a tertiary-care center with medication shortages, few oncologic inpatients were aware of shortages. Participants preferred having multiple decision makers involved in principle-driven allocation of scarce medications. Disclosure was preferred when their usual medications needed to be substituted with equivalent alternatives. These preliminary data suggest that preferences do not align with current management practices for medication shortages.
美国医院的药物短缺问题持续存在且广泛存在，经常涉及癌症治疗中使用的抗肿瘤和支持性药物。药物短缺的管理方式和医患沟通方式各不相同，但尚未明确相关肿瘤患者的偏好。本研究旨在定性评估患者的偏好。
本研究为 2019 年 1 月至 6 月进行的一项横断面、半结构式访谈研究。参与者为在芝加哥大学接受初级癌症治疗、在过去 2 年内接受过治疗且在此期间有 1 次或多次住院经历的成年肿瘤科住院患者。参与者（n=54）连续从交替的血液科和肿瘤科服务中选择。主要结局为对药物短缺意识、决策者选择原则偏好、治疗药物分配偏好以及分配相关沟通等领域的主题达成饱和度。
39 名参与者完成研究程序后达到主题饱和度（平均年龄 59.6 岁[标准差 14.5 岁]；男性占研究人群的 61.5%[平均年龄 24 岁]；应答率 72.0%）。总体而言，18%的参与者了解机构药物短缺情况。在发生短缺时，患者更倾向于有多个决策者来分配药物。大多数患者将肿瘤学家（100%）、伦理学家（92%）、非肿瘤学医生（77%）和药剂师（64%）作为首选决策者。参与者倾向于根据药物的疗效进行药物分配（归一化加权平均值为 1.3），他们还倾向于优先考虑正在接受治疗的人（1.8）、年轻患者（2.0）、病情更重的患者（3.1）和首先接受治疗的患者（5.3）。大多数参与者更倾向于披露支持性护理药物短缺（74%）和抗肿瘤药物短缺（79%），以便进行等效替代。
在一家有药物短缺的三级保健中心，少数肿瘤住院患者了解短缺情况。原则上，参与者更倾向于让多个决策者参与稀缺药物的分配。当需要用等效替代品替代他们常用的药物时，应优先披露信息。这些初步数据表明，患者的偏好与目前的药物短缺管理实践并不一致。
