Endoscopy Unit, North Tees Hospital, University Hospital North Tees and Hartlepool, Stockton-On-Tees, England.
Gastroenterology, North Tyneside General Hospital, North Shields, England.
Colorectal Dis. 2021 Aug;23(8):2052-2061. doi: 10.1111/codi.15743. Epub 2021 Jun 16.
A diagnosis of colorectal polyp cancer presents a treatment dilemma. The decision between segmental resection versus endoscopic surveillance is difficult due to a lack of good quality clinical evidence for either option. The aim of this study was to understand the decision making experiences of both clinicians and patients when faced with such a diagnosis.
Qualitative, semi-structured interviews were undertaken with 10 clinicians involved in the care of patients diagnosed with polyp cancer and five patients who had experience of a diagnosis of polyp cancer. All clinicians and patients were from four hospital trusts across the north of England. Interviews were audio-recorded, transcribed verbatim and analysed using the principles of interpretative phenomenological analysis.
Analysis of the interview transcripts evidenced that clinicians and patients were supportive of a shared approach to treatment decision making in the context of a diagnosis of colorectal polyp cancer. Uncertainty, influences and information were among the themes identified to be preventing this happening at present. This study identified themes which were common to both groups. These were complexity of the risk information, lack of patient information resources, and system factors and time.
This research study has evidenced several factors such as uncertainty, complexity of risk information and influences on decisions which are preventing patients being involved in treatment decisions following a diagnosis of colorectal polyp cancer. Recommendations for improvements in practice, including a framework to assist treatment decision making in the future, are highlighted.
结直肠息肉癌的诊断带来了治疗上的困境。由于缺乏高质量的临床证据支持这两种选择，因此很难在节段性切除与内镜监测之间做出决策。本研究旨在了解临床医生和患者在面临此类诊断时的决策体验。
对 10 名参与治疗息肉癌患者的临床医生和 5 名有息肉癌诊断经验的患者进行了定性、半结构式访谈。所有临床医生和患者均来自英格兰北部的四个医院信托基金。访谈进行了录音、逐字转录，并采用解释现象学分析的原则进行了分析。
对访谈记录的分析表明，在结直肠息肉癌的诊断背景下，临床医生和患者都支持采取共同的治疗决策方法。目前，不确定性、影响因素和信息是阻碍这种情况发生的因素。本研究确定了两组共同的主题。这些主题包括风险信息的复杂性、患者信息资源的缺乏以及系统因素和时间。
这项研究表明，有几个因素，如不确定性、风险信息的复杂性和对决策的影响，阻碍了患者在结直肠息肉癌诊断后参与治疗决策。本文强调了改进实践的建议，包括未来协助治疗决策的框架。
