Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts.
J Pain Symptom Manage. 2021 Sep;62(3):512-522. doi: 10.1016/j.jpainsymman.2021.01.129. Epub 2021 Feb 5.
Patient-provider communication impacts how patients with cancer make decisions about treatment.
To examine patient perceptions of discussions, decision-making, and psychosocial burdens related to receiving palliative radiotherapy (RT), in order to inform best practices for communication about palliative RT.
We conducted an exploratory qualitative study using oral questionnaires and semi-structured interviews. Seventeen patients receiving their first course of palliative RT for lung or bone metastases at a comprehensive cancer center were interviewed. Patient interviews were transcribed verbatim and thematically analyzed using NVivo software.
Themes that impacted patients' decisions to initiate RT included a desire to minimize pain, optimism about what RT could provide for the future, perception of having "no other choice," disappointment about cancer progression, and unfamiliarity with RT. Most patients preferred shared decision-making regarding RT initiation and reported patient empowerment, effective communication, and team collaboration as contributing to shared decision-making. Most patients preferred their physicians to make decisions about RT treatment intensity and described trust in their physicians, institutional reputation, and RT expertise as motivators for this preference. Patients who possessed a proactive decisional mindset about initiating RT as opposed to having "no other choice" were less likely to report experiencing psychosocial burdens.
Most patients prefer shared decision-making regarding RT initiation but prefer their radiation oncologists to make decisions regarding treatment intensity. Communication that empowers patients in their desired level of engagement for RT decision-making may help patients make informed decisions, contribute toward a proactive decisional mindset, and reduce their perception of psychosocial burdens.
医患沟通会影响癌症患者在治疗决策方面的表现。
探讨患者对接受姑息性放疗（RT）相关讨论、决策和心理社会负担的看法，为沟通姑息性 RT 提供最佳实践信息。
我们在一家综合性癌症中心进行了一项探索性的定性研究，采用口头问卷和半结构化访谈。采访了 17 名正在接受首次肺或骨转移姑息性 RT 治疗的患者。患者访谈逐字转录，并使用 NVivo 软件进行主题分析。
影响患者启动 RT 决定的主题包括减轻疼痛的愿望、对 RT 未来可能提供的乐观态度、认为“别无选择”、对癌症进展的失望以及对 RT 的不熟悉。大多数患者希望共同决策启动 RT，并报告患者授权、有效沟通和团队合作有助于共同决策。大多数患者更希望他们的医生决定 RT 治疗强度，并描述对医生的信任、机构声誉和 RT 专业知识是这种偏好的动机。与“别无选择”相比，对启动 RT 具有积极决策思维的患者不太可能报告存在心理社会负担。
大多数患者希望共同决策启动 RT，但希望他们的放射肿瘤学家决定治疗强度。赋予患者在 RT 决策中期望的参与程度的沟通，可能有助于患者做出明智的决策，促进积极的决策思维，并减少他们对心理社会负担的感知。
