Schumacher Frank A, Helenowski Irene B, Oswald Laura B, Gonzalez Brian D, Benning James T, Morgans Alicia K
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Program of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
Patient Prefer Adherence. 2022 Jan 28;16:235-244. doi: 10.2147/PPA.S334827. eCollection 2022.
Multiple treatments for metastatic prostate cancer have similar efficacy, leaving patients with complicated treatment choices. Shared decision-making can facilitate difficult treatment decisions, but the extent to which this is used for metastatic prostate cancer is unknown. We assessed patient, caregiver, and physician perceptions of decision locus of control (shared decision-making vs physician- or patient-directed decisions) and the degree of agreement between groups.
Triads of patients, caregivers, and physicians completed surveys of decision-making practices after a clinic visit in which a decision occurred. To evaluate the degree of agreement for decision locus of control, we used the quadratic-weighted kappa coefficient (κ). We used relative frequencies to evaluate which knowledge learned and treatment factors were most strongly endorsed by patients as informing and influencing their treatment decision-making, respectively.
Fifty triads participated, with median patient age of 72 years. A majority of patients, caregivers, and physicians reported shared decision-making (66%, 56%, and 52%, respectively). Patients and physicians demonstrated minimal agreement about decision locus of control (44%, κ=0.35 [SD = 0.52]), but caregiver reports were not statistically significantly associated with physician and patient reports (38%, κ=0.23, [SD = 0.28]), =0.055; 44%, κ=0.34 [SD = 1.98], =0.14). Treatment efficacy was the most common patient-reported factor influencing treatment decisions (44%).
This study characterized metastatic prostate cancer patients', caregivers', and physicians' experiences and communication preferences for treatment decision-making. Patients and physicians had greater agreement in decision locus of control compared with caregivers, yet patient-physician agreement was minimal. Metastatic prostate cancer patients report being influenced by information about treatment efficacy and clear next steps, and a desire for patient-friendly language and an invitation to be as involved in decision making at their preferred level. Emphasizing these may increase agreement in decision locus of control between all participants in the decision-making process.
转移性前列腺癌的多种治疗方法疗效相似，这使得患者面临复杂的治疗选择。共同决策有助于做出艰难的治疗决策，但在转移性前列腺癌治疗中该方法的应用程度尚不清楚。我们评估了患者、护理人员和医生对决策控制源（共同决策与医生主导或患者主导的决策）的看法以及各群体之间的一致程度。
患者、护理人员和医生三人组在门诊就诊做出决策后完成了关于决策实践的调查。为了评估决策控制源的一致程度，我们使用了二次加权kappa系数（κ）。我们使用相对频率来评估哪些所学知识和治疗因素分别得到患者的最强烈认可，从而为他们的治疗决策提供信息并影响其治疗决策。
五十个三人组参与了研究，患者的中位年龄为72岁。大多数患者、护理人员和医生报告采用共同决策（分别为66%、56%和52%）。患者和医生在决策控制源方面的一致性最低（44%，κ=0.35[标准差=0.52]），但护理人员的报告与医生和患者的报告在统计学上无显著关联（38%，κ=0.23，[标准差=0.28]，P=0.055；44%，κ=0.34[标准差=1.98]，P=0.14）。治疗效果是患者报告的影响治疗决策的最常见因素（44%）。
本研究描述了转移性前列腺癌患者、护理人员和医生在治疗决策方面的经历和沟通偏好。与护理人员相比，患者和医生在决策控制源方面的一致性更高，但医患之间的一致性最低。转移性前列腺癌患者报告称，治疗效果信息和明确的后续步骤会对他们产生影响，他们希望使用便于患者理解的语言，并希望能在自己偏好的程度上参与决策。强调这些方面可能会增加决策过程中所有参与者在决策控制源方面的一致性。
