Colombo Francesca, Maye Helen, Rutherford Scott, King Andrew, Hammerbeck-Ward Charlotte, Whitfield Gillian A, McBain Catherine, Colaco Rovel, Entwistle Helen, Wadeson Andrea, Lloyd Simon, Freeman Simon, Pathmanaban Omar N
Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester, UK.
Department of Neuro-Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK.
Neurooncol Adv. 2023 Jul 19;5(1):vdad089. doi: 10.1093/noajnl/vdad089. eCollection 2023 Jan-Dec.
Our neurosurgical unit adopted a model of shared decision-making (SDM) based on multidisciplinary clinics for vestibular schwannoma (VS). A unique feature of this clinic is the interdisciplinary counseling process with a surgeon presenting the option of surgery, an oncologist radiosurgery or radiotherapy, and a specialist nurse advocating for the patient.
This is a retrospective cohort study. All new patients seen in the combined VS clinic and referred from the skull base multidisciplinary team (MDT) from beginning of June 2013 to end of January 2019 were included. Descriptive statistics and frequency analysis were carried out for the full cohort.
Three hundred and fifty-four patients presenting with new or previously untreated VS were included in the analysis. In our cohort, roughly one-third of patients fall into each of the treatment strategies with slightly smaller numbers of patients undergoing surgery than watch, wait and rescan (WWR) ,and SRS (26.6% vs. 32.8% and 37.9%, respectively).
In our experience, the combined surgery/oncology/specialist nurse clinic streamlines the patient experience for those with a VS suitable for either microsurgical or SRS/radiotherapy treatment. Decision-making in this population of patients is complex and when presented with all treatment options patients do not necessarily choose the least invasive option as a treatment. The unique feature of our clinic is the multidisciplinary counseling process with a specialist nurse advocating and guiding the patient. Treatment options are likely to become more rather than less complex in future years making combined clinics more valuable than ever in the SDM process.
我们的神经外科单元采用了一种基于多学科诊所的前庭神经鞘瘤（VS）共同决策模型。该诊所的一个独特之处在于跨学科咨询过程，外科医生介绍手术选择，肿瘤学家介绍放射外科或放射治疗，专科护士为患者提供支持。
这是一项回顾性队列研究。纳入了2013年6月至2019年1月期间在联合VS诊所就诊并由颅底多学科团队（MDT）转诊的所有新患者。对整个队列进行了描述性统计和频率分析。
分析纳入了354例新发或既往未治疗的VS患者。在我们的队列中，大约三分之一的患者采用每种治疗策略，接受手术的患者数量略少于观察、等待和复查（WWR）以及立体定向放射外科（SRS）的患者（分别为26.6%对32.8%和37.9%）。
根据我们的经验，联合外科/肿瘤学/专科护士诊所简化了适合显微手术或SRS/放射治疗的VS患者的就医体验。这类患者的决策很复杂，当提供所有治疗选择时，患者不一定会选择侵入性最小的治疗方案。我们诊所的独特之处在于跨学科咨询过程，由专科护士为患者提供支持和指导。未来几年，治疗选择可能会变得更加复杂而非简单，这使得联合诊所在共同决策过程中比以往任何时候都更有价值。
