Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany.
Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany.
Z Evid Fortbild Qual Gesundhwes. 2022 Aug;172:40-48. doi: 10.1016/j.zefq.2022.04.026. Epub 2022 Jun 24.
Cancer patients are facing a variety of treatment and other disease-related decisions. This study aims to provide insights into preferred and perceived participation roles in decision-making among patients with diverse tumors using the German Cancer Information Service (CIS).
Patients' decision-making preferences and experiences were assessed as a part of a cross-sectional survey among CIS users. An adapted version of the Control Preferences Scale (CPS) was used to assess preferred and perceived participation roles in eight different areas of medical decision-making (e.g., choice of medication, termination of treatment). Logistic regression analyses were applied to explore preference matching and to analyze associations between participation roles and sociodemographic variables. Moreover, we examined preferences and perceptions of participation roles across different decision situations.
In the final sample (N = 1566, 64.9% female, mean age = 61.6), almost half of the patients (47.1%) preferred to take a collaborative role in decisions on treatment methods, whereas 36.3% preferred an active role and 15.9% a passive role. Collaborative role preferences frequently (40.7%) coincided with experiencing a passive role and predicted a reduced chance of a match between preferences and experiences (OR = 0.57, p = .001). A higher level of education was associated with a lower chance of preferring and perceiving a passive role (OR = 0.85, p < .01). Compared with men, women had increased odds of preferring (OR = 1.45, p < .05) and of actually taking (OR = 2.04, p < .001) a passive role in medical encounters. Preferred participation roles regarding treatment methods were highly correlated with preferences in all other decision areas (r > .50, p < .001) except decisions about family involvement.
The study reveals well-known deficits in the fulfilment of patients' collaborative role preferences across different areas of medical decision-making in a sample of CIS users characterized by high information-seeking behavior. Participation roles were not only influenced by the patients' level of education but also by their gender. The gender effect may be more pronounced than previous studies suggest. These effects should be considered in the development of interventions to promote shared decision-making. Additionally, study results indicate that preferences for participation in decisions about treatment methods, as assessed by the CPS, can be generalized to other areas of medical decision-making.
癌症患者面临着各种治疗和其他与疾病相关的决策。本研究旨在通过德国癌症信息服务（CIS），了解不同肿瘤患者在决策中的偏好和感知参与角色。
作为 CIS 用户的横断面调查的一部分，评估了患者的决策偏好和经验。使用改编的控制偏好量表（CPS）评估了在医疗决策的八个不同领域（例如，药物选择、治疗终止）中偏好和感知的参与角色。应用逻辑回归分析来探索偏好匹配，并分析参与角色与社会人口学变量之间的关联。此外，我们还检查了不同决策情况下参与角色的偏好和看法。
在最终样本（N=1566，64.9%为女性，平均年龄=61.6）中，近一半的患者（47.1%）倾向于在治疗方法决策中采取协作角色，而 36.3%的患者偏好主动角色，15.9%的患者偏好被动角色。协作角色偏好经常（40.7%）与体验被动角色相符，并预测偏好与经验之间的匹配机会减少（OR=0.57，p=0.001）。较高的教育水平与较低的偏好和感知被动角色的可能性相关（OR=0.85，p<.01）。与男性相比，女性在医疗接触中更有可能偏好（OR=1.45，p<.05）和实际采取（OR=2.04，p<.001）被动角色。对治疗方法的偏好参与角色与所有其他决策领域（r>.50，p<.001）的偏好高度相关，除了关于家庭参与的决策。
本研究在 CIS 用户样本中发现，在医疗决策的不同领域中，患者的协作角色偏好明显存在不足，这些用户具有较高的信息寻求行为。参与角色不仅受患者教育水平的影响，还受其性别影响。与以往研究相比，性别效应可能更为明显。在制定促进共同决策的干预措施时，应考虑这些影响。此外，研究结果表明，通过 CPS 评估的对治疗决策的参与偏好可以推广到其他医疗决策领域。
