Yale School of Nursing, PO Box 27399, West Haven, CT, 06516, USA.
Yale School of Public Health, New Haven, CT, USA.
Patient. 2020 Dec;13(6):683-697. doi: 10.1007/s40271-020-00426-7.
While clinical pathways have been widely adopted to decrease variation in cancer treatment patterns, they do not always incorporate patient and family caregiver perspectives. We identified shared patient and family caregiver considerations influencing treatment preferences/decision making to inform development of a shared decision pathway.
We conducted qualitative interviews with women who completed initial definitive treatment for stage I-III breast cancer and their family caregivers. As part of a broader interview, we asked participants what they considered when choosing a treatment option for themselves/their loved one. We coded transcribed interviews, analyzed patient and family caregiver datasets separately, and compared findings. Findings Patients' (n = 22) mean age was 55.7 years, whereas family caregivers' (n = 20) mean age was 59.5 years, with most (65%) being patients' spouses/partners. Considerations reported by both groups included cancer status, treatment issues, physical/psychosocial/family consequences, and provider/health care system issues. Data revealed three key tensions that arise during treatment decision making: (1) having enough information to set expectations but not so much as to be overwhelming; (2) balancing the highest likelihood of cure with potential physical/emotional/social/financial consequences of the chosen treatment; and (3) wanting to make data-driven decisions while having a personalized treatment plan.
Patients and family caregivers identified several considerations of shared relevance reflecting different perspectives. Efforts to balance considerations can produce tensions that may contribute to decision regret if unaddressed.
Clinical pathways can increase exposure to decision regret if treatment options are selected without consideration of patients' priorities. A shared decision pathway that incorporates patient-centeredness could facilitate satisfactory decision making.
虽然临床路径已被广泛采用以减少癌症治疗模式的差异，但它们并不总是纳入患者和家属照顾者的观点。我们确定了影响治疗偏好/决策的共同患者和家属考虑因素，以为共同决策路径的制定提供信息。
我们对完成 I-III 期乳腺癌初始确定性治疗的女性及其家属照顾者进行了定性访谈。作为更广泛访谈的一部分，我们询问了参与者在为自己/亲人选择治疗方案时考虑了哪些因素。我们对转录的访谈进行了编码分析，分别分析了患者和家属照顾者的数据组，并比较了发现。结果患者（n=22）的平均年龄为 55.7 岁，而家属照顾者（n=20）的平均年龄为 59.5 岁，大多数（65%）是患者的配偶/伴侣。两组报告的考虑因素包括癌症状况、治疗问题、身体/心理社会/家庭后果以及提供者/医疗保健系统问题。数据揭示了在治疗决策过程中出现的三个关键紧张局势：（1）有足够的信息来设定期望，但不要过多以至于压倒性；（2）平衡治愈的可能性与所选治疗方案的潜在身体/情感/社会/财务后果；（3）希望在制定数据驱动的决策的同时制定个性化的治疗计划。
患者和家属照顾者确定了几个具有共同相关性的考虑因素，反映了不同的观点。如果不考虑患者的优先事项，平衡考虑因素可能会产生紧张局势，如果不加以解决，可能会导致决策后悔。
如果不考虑患者的优先权选择治疗方案，临床路径可能会增加决策后悔的风险。纳入以患者为中心的共同决策路径可以促进满意的决策制定。
