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复发性卵巢癌的共同决策:丹麦三个肿瘤科对患者决策辅助工具的应用

Shared decision making in recurrent ovarian cancer: Implementation of patient decision aids across three departments of oncology in Denmark.

作者信息

Wulff Christian Nielsen, Hæe Mette, Hansen Dorte Gilså, Olling Karina, Jensen Karina Mølgaard, Knudsen Anja Ør, Fokdal Lars, Steffensen Karina Dahl

机构信息

Department of Oncology, Aarhus University Hospital, Denmark.

Department of Clinical Medicine, Aarhus University, Denmark.

出版信息

PEC Innov. 2022 Nov 1;1:100095. doi: 10.1016/j.pecinn.2022.100095. eCollection 2022 Dec.

Abstract

OBJECTIVE

Patients with relapsed ovarian cancer are offered multiple treatment options. To match treatment with the individual patient's life situation and preferences, healthcare professionals can apply shared decision making (SDM) including patient decision aids (PtDAs).This study aimed to evaluate the implementation of two different PtDAs in consultations with patients suffering from relapsed ovarian cancer.

METHODS

We analyzed the following data before and after implementation of the PtDAs: 1) observed SDM using the OPTION instrument, 2) physician treatment recommendations, and 3) patients' and physicians' evaluations of SDM in consultations using the CollaboRATE, SDM-Q-9, and SDM-Q-Doc.

RESULTS

Significant improvement in observed SDM was found after the implementation ( = 0.002). Improvement of SDM was detected in consultations conducted by physicians reporting more than two hours of SDM-training ( < 0.001), but not when physicians reported less than two hours of SDM-training.No before/after differences in treatment recommendations and in patients' and physicians' evaluations were found.

CONCLUSION

Implementation of PtDAs improved the level of observed SDM. Training of physicians in SDM is necessary for improved SDM practice.

INNOVATION

Discussing oncological treatment options with the use of PtDAs is not standard practice in Denmark. The present study is one of the first Danish studies focusing on how to implement SDM and PtDAs in oncological consultations.

摘要

目的

复发性卵巢癌患者有多种治疗选择。为使治疗与患者个体的生活状况和偏好相匹配,医疗保健专业人员可采用包括患者决策辅助工具(PtDAs)在内的共同决策(SDM)。本研究旨在评估在与复发性卵巢癌患者的会诊中实施两种不同PtDAs的情况。

方法

我们分析了PtDAs实施前后的以下数据:1)使用OPTION工具观察到的SDM,2)医生的治疗建议,以及3)使用CollaboRATE、SDM-Q-9和SDM-Q-Doc对会诊中SDM的患者和医生评估。

结果

实施后观察到的SDM有显著改善(P = 0.002)。在报告接受超过两小时SDM培训的医生进行的会诊中检测到SDM的改善(P < 0.001),但在报告接受少于两小时SDM培训的医生进行的会诊中未检测到改善。在治疗建议以及患者和医生评估方面未发现前后差异。

结论

PtDAs的实施提高了观察到的SDM水平。对医生进行SDM培训对于改善SDM实践是必要的。

创新点

在丹麦,使用PtDAs讨论肿瘤治疗方案并非标准做法。本研究是丹麦首批关注如何在肿瘤会诊中实施SDM和PtDAs的研究之一。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/103e/10194381/02dd112719cf/gr1.jpg

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