Lehmann Vicky, Smets Ellen M A, de Jong Maxime, de Vos Filip Y F, Kenter Gemma G, Stouthard Jacqueline M, Hillen Marij A
Department of Medical Psychology, Amsterdam UMC, Amsterdam Public Health, Amsterdam, The Netherlands.
Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
Acta Oncol. 2020 Dec;59(12):1512-1519. doi: 10.1080/0284186X.2020.1794036. Epub 2020 Jul 23.
Cancer patients increasingly seek second opinion (SO) consultations, but there is scarce empirical evidence to substantiate medical and psychological benefits for patients. This is the first study to examine patient- and oncologist-reported (1) motivations and expectations of patients to seek a SO, (2) the perceived medical outcome, and (3) psychological consequences of SOs over time (i.e. patients' uncertainty and anxiety).
This multi-informant longitudinal cohort study (SO-COM) included consecutive cancer patients referred for a SO ( = 70; age 28-85), as well as their referring and consulting oncologists. Outcome measures were completed at three time points: Patients and referring oncologists reported motivations and expectations before the SO (T), patients and consulting oncologists reported the medical outcome of the SO (i.e. discrepancy between first and second opinion) immediately following the SO (T), and patients reported their uncertainty and anxiety at T, T, and two months following the SO (T).
Cancer patients most frequently reported , and/or as motivations for SOs. Referring oncologists rather accurately anticipated these motivations, except most did not recognize patients' information needs. The vast majority of patients (90.0%) received a medical advice similar to the first opinion, although 65.7% had expected to receive a different opinion. Patients' uncertainty ( = 6.82, =.002; =.22), but not anxiety ( = 3.074, =.055, =.11) was significantly reduced after the SO.
SOs can yield psychological benefits by reducing patients' uncertainty, but the added medical value remains debatable. Referring oncologists may not be fully aware of their patients' information needs. Patients should be better informed about goals and benefits of SOs to better manage their expectations. More cost-effective ways of optimally providing medically and psychologically valuable SOs need to be explored.
癌症患者越来越多地寻求二次诊断（SO）咨询，但几乎没有实证证据能证实这对患者有医学和心理益处。这是第一项研究患者和肿瘤学家报告的（1）患者寻求二次诊断的动机和期望，（2）感知到的医疗结果，以及（3）随时间推移二次诊断的心理后果（即患者的不确定性和焦虑）的研究。
这项多信息纵向队列研究（SO-COM）纳入了连续转诊进行二次诊断的癌症患者（n = 70；年龄28 - 85岁），以及他们的转诊肿瘤学家和会诊肿瘤学家。在三个时间点完成结果测量：患者和转诊肿瘤学家在二次诊断前（T1）报告动机和期望，患者和会诊肿瘤学家在二次诊断后立即（T2）报告二次诊断的医疗结果（即首次和第二次意见之间的差异），患者在T1、T2以及二次诊断后两个月（T3）报告他们 的不确定性和焦虑。
癌症患者最常报告 、 和/或 作为寻求二次诊断的动机。转诊肿瘤学家相当准确地预测了这些动机，不过大多数人没有认识到患者的信息需求。绝大多数患者（90.0%）收到了与首次意见相似的医疗建议，尽管65.7%的患者原本期望得到不同的意见。二次诊断后患者的不确定性显著降低（t = 6.82，p =.002；d =.22），但焦虑没有显著降低（t = 3.074，p =.055，d =.11）。
二次诊断可以通过减少患者的不确定性产生心理益处，但额外的医学价值仍有争议。转诊肿瘤学家可能没有完全意识到患者的信息需求。应该让患者更好地了解二次诊断的目标和益处，以便更好地管理他们的期望。需要探索更具成本效益的方式来最佳地提供具有医学和心理价值的二次诊断。
