Austin Jessica D, Shelton Elizabeth, Crookes Danielle M, Tehranifar Parisa, Neugut Alfred I, Shelton Rachel C
Division of Epidemiology, Mayo Clinic College of Medicine and Sciences, Scottsdale, AZ, USA.
Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
MDM Policy Pract. 2023 Mar 27;8(1):23814683231163189. doi: 10.1177/23814683231163189. eCollection 2023 Jan-Jun.
To explore preferred and actual involvement in chemotherapy decision making among stage II and III colon cancer (CC) patients by sociodemographic, interpersonal, and intrapersonal communication factors. Cross-sectional exploratory study collecting self-reported survey data from stage II and III CC patients from 2 cancer centers located in northern Manhattan. Of 88 patients approached, 56 completed the survey. Only 19.3% reported shared involvement in their chemotherapy decisions. We observed significant differences in preferred involvement by gender, with women preferring more physician-controlled decisions. CC patients with higher levels of decisional self-efficacy significantly preferred shared decisions ( = 4.4 [2], = 0.02). Actual involvement in decisions differed by race (physician controlled 33% for White v. 67% for Other, < 0.01), age (shared control 18% for ≤55 y, 55% for 55-64 y, and 27% for 65+ y, = 0.04), and perception of choice (shared control 73% "yes" v. 27% "no," = 0.02). Actual or preferred involvement did not differ by stage. Significantly higher levels of medical mistrust (discrimination = 2.8 [50], .01; lack of support = 3.6 [49], < 0.01), and lower levels of decisional self-efficacy ( = 2.5 [49], .01) were reported among women. Reports of shared involvement around chemotherapy decisions is limited among CC patients. Factors influencing preferred versus actual chemotherapy decision making are complex and may differ; hence, more research is needed to understand and address factors contributing to discordance between preferred and actual involvement in chemotherapy decision making for CC patients.
Shared involvement around chemotherapy decisions remains limited for patients diagnosed with colon cancer.Sociodemographic (age, race, gender), interpersonal (medical mistrust), and intrapersonal (decisional self-efficacy, perception of choice) factors that influence preferred involvement in chemotherapy decision making may differ from those influencing actual involvement in chemotherapy decision making.Shared involvement in chemotherapy decisions may look different than currently conceptualized, notably when uncertainty around the benefits exists.
通过社会人口学、人际和个人沟通因素，探讨II期和III期结肠癌（CC）患者在化疗决策中的偏好参与度和实际参与情况。横断面探索性研究，收集了位于曼哈顿北部的2个癌症中心的II期和III期CC患者的自我报告调查数据。在88名被邀请的患者中，56名完成了调查。只有19.3%的患者报告在化疗决策中有共同参与。我们观察到在偏好参与度方面存在显著的性别差异，女性更倾向于由医生主导决策。决策自我效能水平较高的CC患者明显更倾向于共同决策（平均值 = 4.4 [2]，P = 0.02）。实际参与决策因种族（白人患者中医生主导为33%，其他种族为67%，P < 0.01）、年龄（≤55岁患者中共同控制为18%，55 - 64岁为55%，65岁及以上为27%，P = 0.04）以及对选择的认知（共同控制中“是”为73%，“否”为27%，P = 0.02）而有所不同。实际或偏好的参与度在分期上没有差异。女性报告的医疗不信任程度显著更高（歧视平均值 = 2.8 [50]，P < 0.01；缺乏支持平均值 = 3.6 [49]，P < 0.01），决策自我效能水平更低（平均值 = 2.5 [49]，P < 0.01）。CC患者中关于化疗决策共同参与的报告有限。影响偏好与实际化疗决策的因素复杂且可能不同；因此，需要更多研究来理解和解决导致CC患者在化疗决策中偏好参与度与实际参与度不一致的因素。
对于被诊断为结肠癌的患者，化疗决策的共同参与仍然有限。影响化疗决策偏好参与度社会人口学因素（年龄、种族、性别）、人际因素（医疗不信任）和个人因素（决策自我效能、对选择的认知）可能与影响化疗决策实际参与度的因素不同。化疗决策的共同参与可能与目前的概念化情况不同，特别是在存在益处不确定性的时候。
