Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK.
St James' Institute of Oncology, Beckett Street, Leeds, LS9 7TF, UK.
Health Qual Life Outcomes. 2020 Jul 18;18(1):237. doi: 10.1186/s12955-020-01496-9.
In early-stage Non-Small Cell Lung Cancer (NSCLC) patients, little is known about how to measure patient participation in Shared-Decision Making (SDM). We examined the psychometric properties and clinical acceptability of the Decision Self-Efficacy scale (DSE) in a cohort of patients undergoing to Stereotactic Ablative Radiotherapy (SABR) or Video-assisted Thoracoscopic Surgery (VATS) to capture patient involvement in treatment decisions.
In the context of a prospective longitudinal study (Life after Lung Cancer-LiLAC) involving 244 patients with early-stage NSCLC, 158 (64.7%) patients completed the DSE either on paper or electronically online prior to treatment with SABR or VATS pulmonary resection. DSE psychometric properties were examined using: principal components analysis of item properties and internal structure, and internal construct validity; we also performed a sensitivity analysis according to Eastern Cooperative Oncology Group Performance Status (ECOG PS), gender, age and treatment received (VATS or SABR) difference.
Exploratory factor analysis using polychoric correlations substantiated that the 11 item DSE is one scale accounting for 81% of the variance. We calculated a value of 0.96 for Cronbach's alpha for the total DSE score. DSE scores did not differ by gender (p = 0.37), between the two treatment groups (p = 0.09) and between younger and older patients (p = 0.4). However, patients with an ECOG PS > 1 have a DSE mean of 73.8 (SD 26) compared to patients with a PS 0-1 who have a DSE mean of 85.8 (SD 20.3 p = 0.002).
Findings provide preliminary evidence for the reliability and validity of the DSE questionnaire in this population. However, future studies are warranted to identify the most appropriate SDM tool for clinical practice in the lung cancer treatment field.
在早期非小细胞肺癌（NSCLC）患者中，对于如何衡量患者参与共同决策（SDM）的情况，人们知之甚少。我们在接受立体定向消融放疗（SABR）或电视辅助胸腔镜手术（VATS）治疗的患者队列中，检查了决策自我效能感量表（DSE）的心理测量特性和临床可接受性，以捕捉患者在治疗决策中的参与度。
在一项涉及 244 例早期 NSCLC 患者的前瞻性纵向研究（肺癌后生活-LiLAC）中，158 例（64.7%）患者在接受 SABR 或 VATS 肺切除术治疗前，通过纸质或电子在线方式完成了 DSE。通过以下方式检查 DSE 的心理测量特性：项目属性和内部结构的主成分分析以及内部结构效度；我们还根据东部合作肿瘤学组表现状态（ECOG PS）、性别、年龄和治疗方法（VATS 或 SABR）的差异进行了敏感性分析。
使用偏相关的探索性因素分析证实，11 项 DSE 是一个量表，占 81%的方差。我们计算出 DSE 总分的 Cronbach's alpha 值为 0.96。DSE 评分不因性别（p=0.37）、两种治疗组之间（p=0.09）或年轻患者与老年患者之间（p=0.4）而有所不同。然而，ECOG PS>1 的患者的 DSE 平均值为 73.8（SD 26），而 PS 0-1 的患者的 DSE 平均值为 85.8（SD 20.3，p=0.002）。
这些发现为该人群中 DSE 问卷的可靠性和有效性提供了初步证据。然而，未来的研究需要确定在肺癌治疗领域中最适合临床实践的 SDM 工具。
