Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Oral Oncol. 2021 Jan;112:105044. doi: 10.1016/j.oraloncology.2020.105044. Epub 2020 Oct 30.
Oropharyngeal squamous cell cancer (OPSCC) is now the most common site of head and neck squamous cell cancer. Despite the focus on treatment deintensification in clinical trials, little is known about the preferences, experiences and needs of patients with OPSCC when deciding between surgery and radiation therapy as primary treatment with curative intent. In this qualitative study, pre-treatment and post-treatment oropharyngeal cancer patients were recruited to take part in one-on-one interviews (n = 11 pre-treatment) and focus group discussions (n = 15 post-treatment) about treatment decision-making. Recordings were transcribed and assessed for emergent themes using framework analysis. From the one-on-one interviews and focus group discussions with OPSCC patients, fourteen themes were identified. Participants expressed alarm at diagnosis, decisional conflict, and a variety of roles in decision-making (physician-controlled, shared, and autonomous). Decisions were driven by the perceived recommendation of the treatment team, a desire for physical (surgical) tumor removal, fear of adverse effects of treatment, and patient-specific values. Although participants felt well-informed by their treating physicians, they identified a need for additional patient-centered information. Participants were critical of the poor quality of information available on the internet, and acknowledged the advantage of hearing the experiences of post-treatment patients. The experiences identified herein may be used to guide patient-centered communication during patient counseling and to inform interventions designed to support patients' needs at diagnosis, ultimately helping to implement high-quality, patient-centered care.
口咽鳞状细胞癌（OPSCC）现在是头颈部鳞状细胞癌最常见的部位。尽管临床试验集中在治疗减量化上，但对于 OPSCC 患者在选择手术和放疗作为根治性治疗时的偏好、经验和需求知之甚少。在这项定性研究中，招募了治疗前和治疗后的口咽癌患者，让他们参与一对一访谈（n=11 名治疗前）和焦点小组讨论（n=15 名治疗后），讨论治疗决策。使用框架分析对记录进行转录和评估，以确定出现的主题。从 OPSCC 患者的一对一访谈和焦点小组讨论中，确定了 14 个主题。参与者对诊断、决策冲突以及决策中的各种角色（医生控制、共同和自主）表示震惊。决策是由治疗团队的建议、对物理（手术）肿瘤切除的渴望、对治疗副作用的恐惧以及患者特定的价值观驱动的。尽管参与者认为他们的治疗医生提供了很好的信息，但他们认为需要更多以患者为中心的信息。参与者对互联网上可用信息质量差提出批评，并承认听取治疗后患者的经验的优势。本文确定的经验可用于指导患者咨询过程中的以患者为中心的沟通，并为满足患者诊断时需求的干预措施提供信息，最终有助于实施高质量、以患者为中心的护理。
