Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany.
Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Cancer Med. 2022 Aug;11(15):2999-3008. doi: 10.1002/cam4.4667. Epub 2022 Mar 24.
Patient-centered care and shared decision making (SDM) are generally recognized as the gold standard for medical consultations, especially for preference-sensitive decisions. However, little is known about psychological patient characteristics that influence patient-reported preferences. We set out to explore the role of personality and anxiety for a preference-sensitive decision in bladder cancer patients (choice of urinary diversion, UD) and to determine if anxiety predicts patients' participation preferences.
We recruited a sample of bladder cancer patients (N = 180, primarily male, retired) who awaited a medical consultation on radical cystectomy and their choice of UD. We asked patients to fill in a set of self-report questionnaires before this consultation, including measures of treatment preference, personality (BFI-10), anxiety (STAI), and participation preference (API and API-Uro), as well as sociodemographic characteristics.
Most patients (79%) indicated a clear preference for one of the treatment options (44% continent UD, 34% incontinent UD). Patients who reported more conscientiousness were more likely to prefer more complex methods (continent UD). The majority (62%) preferred to delegate decision making to healthcare professionals. A substantial number of patients reported elevated anxiety (32%), and more anxiety was predictive of higher participation preference, specifically for uro-oncological decisions (β = 0.207, p < 0.01).
Our findings provide insight into the role of psychological patient characteristics for SDM. Aspects of personality such as conscientiousness influence treatment preferences. Anxiety contributes to patients' motivation to be involved in pertinent decisions. Thus, personality and negative affect should be considered to improve SDM.
以患者为中心的护理和共同决策（SDM）通常被认为是医疗咨询的黄金标准，尤其是对于偏好敏感的决策。然而，对于影响患者报告偏好的心理患者特征知之甚少。我们旨在探讨人格和焦虑对膀胱癌患者（选择尿流改道术，UD）偏好敏感决策的作用，并确定焦虑是否预测患者的参与偏好。
我们招募了一组膀胱癌患者（N=180，主要为男性，已退休），他们正在等待根治性膀胱切除术的医疗咨询及其选择的 UD。我们要求患者在咨询前填写一套自我报告问卷，包括治疗偏好、人格（BFI-10）、焦虑（STAI）和参与偏好（API 和 API-Uro）以及社会人口统计学特征的测量。
大多数患者（79%）表示对治疗方案之一有明确偏好（44%选择有节制的 UD，34%选择无节制的 UD）。报告责任心更强的患者更有可能倾向于选择更复杂的方法（有节制的 UD）。大多数患者（62%）选择将决策权委托给医疗保健专业人员。相当数量的患者报告焦虑程度升高（32%），更高的焦虑程度与更高的参与偏好相关，特别是对泌尿肿瘤学决策（β=0.207，p<0.01）。
我们的研究结果提供了对 SDM 中心理患者特征作用的深入了解。人格特质如责任心会影响治疗偏好。焦虑会促进患者参与相关决策的动机。因此，应考虑人格和负面情绪以改善 SDM。
