Huepenbecker Sarah P, Zhang Xiaochen, Morgan Mark A, Haggerty Ashley F
Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
Center for Research on Reproduction and Women's Health, University of Pennsylvania, 3440 Market St, Philadelphia, PA 19104, USA.
Gynecol Oncol Rep. 2022 Jul 8;42:101042. doi: 10.1016/j.gore.2022.101042. eCollection 2022 Aug.
There is limited data comparing patient and physician expectations regarding ovarian cancer prognosis. Our primary objective was to compare physician and patient estimates of survival to 6 months, 1 year, and 5 years; secondary objectives included comparing provider and patient responses on the likelihood of requiring future treatments and categorizing patient and provider preferences regarding communication about prognosis.
A prospective cross-sectional survey was delivered to 10 gynecologic oncology providers and 50 adult ovarian cancer patients from November 2015-April 2016 at one institution. Descriptive statistics were used to categorize survey answers and compare survey answers between patients and providers; multivariable logistic regression evaluated patient survey responses.
All providers (100%) believed treating providers should discuss prognosis and 90% reported having prognostic conversations with patients, compared to 63%, 37%, and 4% of patients who reported discussing prognosis, living wills/advance directives, and palliative care/hospice services, respectively, with their provider. Compared to their provider, patients gave significantly lower estimations of requiring any future therapy (mean score 84.6 vs 74, p <.001) and future chemotherapy (mean score 84.1 vs 69.8, p <.001) and significantly higher estimations of requiring future surgery (mean score 23.3 vs 40, p <.001), achieving remission (mean score 33.5 vs 47.5, p =.009), survival to 1 year (mean score 77.1 vs 86.4, p =.002), and survival to 5 years (mean score 40.5 vs 61.3, p <.001).
Although gynecologic oncology providers believe it is important to discuss prognosis and end-of-life care, there are gaps in communication, knowledge, and expectations between providers and ovarian cancer patients.
关于卵巢癌预后，患者与医生期望的对比数据有限。我们的主要目标是比较医生和患者对6个月、1年及5年生存率的估计；次要目标包括比较医疗服务提供者和患者对未来是否需要治疗的可能性的回答，以及对患者和医疗服务提供者关于预后沟通的偏好进行分类。
2015年11月至2016年4月，在一家机构对10名妇科肿瘤医疗服务提供者和50名成年卵巢癌患者进行了一项前瞻性横断面调查。描述性统计用于对调查答案进行分类，并比较患者和医疗服务提供者之间的调查答案；多变量逻辑回归评估患者的调查反应。
所有医疗服务提供者（100%）认为治疗医生应该讨论预后，90%的人报告与患者进行了预后谈话，相比之下，分别有63%、37%和4%的患者报告与医生讨论了预后、生前遗嘱/预立医疗指示以及姑息治疗/临终关怀服务。与医疗服务提供者相比，患者对未来需要任何治疗（平均得分84.6对74，p<.001）和未来化疗（平均得分84.1对69.8，p<.001）的估计显著更低，而对未来需要手术（平均得分23.3对40，p<.001）、实现缓解（平均得分33.5对47.5，p=.009）、1年生存率（平均得分77.1对86.4，p=.002）以及5年生存率（平均得分40.5对61.3，p<.001）的估计显著更高。
尽管妇科肿瘤医疗服务提供者认为讨论预后和临终关怀很重要，但医疗服务提供者与卵巢癌患者之间在沟通、知识和期望方面存在差距。
