支持老年乳腺癌幸存者监测乳房 X 光检查专家共识指南的伴侣患者指南的可接受性。
Acceptability of a companion patient guide to support expert consensus guidelines on surveillance mammography in older breast cancer survivors.
机构信息
Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
Survey and Qualitative Methods Core for Qualitative and Quantitative Research, Dana-Farber Cancer Institute, Boston, MA, USA.
出版信息
Breast Cancer Res Treat. 2022 Sep;195(2):141-152. doi: 10.1007/s10549-022-06676-3. Epub 2022 Jul 30.
PURPOSE
To support shared decision-making, patient-facing resources are needed to complement recently published guidelines on approaches for surveillance mammography in breast cancer survivors aged ≥ 75 or with < 10-year life expectancy. We created a patient guide to facilitate discussions about surveillance mammography in older breast cancer survivors.
METHODS
The "Are Mammograms Still Right for Me?" guide estimates future ipsilateral and contralateral breast (in-breast) cancer risks, general health, and the potential benefits/harms of mammography, with prompts for discussion. We conducted in-clinic acceptability testing of the guide by survivors and their clinicians at a National Cancer Institute-designated comprehensive cancer center, including two community practices. Patients and clinicians received the guide ahead of a clinic visit and surveyed patients (pre-/post-visit) and clinicians (post-visit). Acceptability was defined as ≥ 75% of patients and clinicians reporting that the guide (a) should be recommended to others, (b) is clear, (c) is helpful, and (d) contains a suitable amount of information. We also elicited feedback on usability and mammography intentions.
RESULTS
We enrolled 45 patients and their 21 clinicians. Among those responding in post-visit surveys, 33/37 (89%) patients and 15/16 (94%) clinicians would recommend the guide to others; 33/37 (89%) patients and 15/16 (94%) clinicians felt everything/most things were clear. All other pre-specified acceptability criteria were met. Most patients reported strong intentions for mammography (100% pre-visit, 98% post-visit).
CONCLUSION
Oncology clinicians and older breast cancer survivors found a guide to inform mammography decision-making acceptable and clear. A multisite clinical trial is needed to assess the guide's impact mammography utilization.
TRIAL REGISTRATION
ClinicalTrials.gov-NCT03865654, posted March 7, 2019.
目的
为了支持共同决策，需要有面向患者的资源来补充最近发布的关于≥75 岁或预期寿命<10 年的乳腺癌幸存者进行监测性乳房 X 线摄影的方法指南。我们创建了一个患者指南，以方便讨论年龄较大的乳腺癌幸存者的监测性乳房 X 线摄影问题。
方法
“乳房 X 线照片对我仍然合适吗？”指南使用提示来估计未来同侧和对侧乳房（乳房内）癌症风险、一般健康状况以及乳房 X 线摄影的潜在益处/危害。我们在一家美国国立癌症研究所指定的综合性癌症中心的诊所中，由幸存者及其临床医生对该指南进行了可接受性测试，包括两个社区实践。患者和临床医生在就诊前收到了指南，并在就诊前后对患者（就诊前/后）和临床医生（就诊后）进行了调查。可接受性定义为≥75%的患者和临床医生报告说，该指南(a) 应推荐给他人，(b) 清晰易懂，(c) 有帮助，以及 (d) 包含适量的信息。我们还征求了有关可用性和乳房 X 线摄影意图的反馈意见。
结果
我们共纳入了 45 名患者及其 21 名临床医生。在接受就诊后调查的患者中，37 名患者中有 33 名（89%）和 16 名临床医生中有 15 名（94%）会向他人推荐该指南；37 名患者中有 33 名（89%）和 16 名临床医生中有 15 名（94%）表示所有事情/大部分事情都清楚。所有其他预先指定的可接受性标准均得到满足。大多数患者表示强烈希望进行乳房 X 线摄影（就诊前 100%，就诊后 98%）。
结论
肿瘤学临床医生和年龄较大的乳腺癌幸存者认为，指导决策的指南是可以接受的，并且清晰易懂。需要进行多中心临床试验来评估该指南对乳房 X 线摄影利用率的影响。
试验注册
ClinicalTrials.gov-NCT03865654，2019 年 3 月 7 日注册。
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