Gu Xiao-Fen, Xu Hui-Fang, Liu Yin, Li Li, Yu Yan-Qin, Zhang Xi, Wang Xiao-Hui, Wang Wen-Jun, Du Ling-Bin, Duan Shuang-Xia, Cao He-Lu, Zhao Yu-Qian, Liu Yun-Yong, Huang Juan-Xiu, Cao Ji, Fan Yan-Ping, Feng Chang-Yan, Lian Xue-Mei, Du Jing-Chang, Rezhake Remila, Ma Li, Qiao You-Lin
Department of Student Affairs, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, China.
Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China.
Front Oncol. 2023 Jul 26;13:1168078. doi: 10.3389/fonc.2023.1168078. eCollection 2023.
This cross-sectional study evaluated the involvement of patients with advanced colorectal cancer (CRC) in treatment decision-making, assessed the treatment efficacy according to their self-reports, and investigated the influencing factors.
Patients with advanced CRC were recruited from 19 hospitals from March 2020 to March 2021 by a multi-stage multi-level sampling method. A self-designed questionnaire was used to collect demographic and clinical characteristics, involvement of CRC patients in treatment decision-making, treatment methods, and self-reported efficacy. Univariate and unordered multinomial logistic regression analyses were used to evaluate the factors affecting the involvement in treatment decision-making and self-reported efficacy.
We enrolled 4533 patients with advanced CRC. The average age at diagnosis was 58.7 ± 11.8 years. For the treatment method, 32.4% of patients received surgery combined with chemotherapy, 13.1% of patients underwent surgery combined with chemotherapy and targeted therapy, and 9.7% of patients were treated with surgery alone. For treatment decision-making, 7.0% of patients were solely responsible for decision-making, 47.0% of patients shared treatment decision-making with family members, 19.0% of patients had family members solely responsible for treatment decision-making, and 27.0% of patients had their physicians solely responsible for treatment decision-making. Gender, age, education level, family income, marital status, treatment cost, hospital type, and treatment method were significantly associated with the involvement of patients in treatment decision-making. A total of 3824 patients submitted self-reported efficacy evaluations during treatment. The percentage of patients with good self-reported efficacy was 76.5% (for patients treated for the first time), 61.7% (for patients treated for the second time), and 43.2% (for patients treated after recurrence and metastasis), respectively. Occupation, education level, average annual family income, place of residence, time since cancer diagnosis, hospital type, clinical stage, targeted therapy, and involvement in treatment decision-making were the main influencing factors of self-reported efficacy of treatment.
Conclusively, CRC patients are not highly dominant in treatment decision-making and more likely to make treatment decisions with their family and doctors. Timely and effective communication between doctors and patients can bolster patient involvement in treatment decision-making.
本横断面研究评估了晚期结直肠癌（CRC）患者参与治疗决策的情况，根据患者的自我报告评估了治疗效果，并调查了影响因素。
2020年3月至2021年3月，采用多阶段多级抽样方法从19家医院招募晚期CRC患者。使用自行设计的问卷收集人口统计学和临床特征、CRC患者参与治疗决策的情况、治疗方法以及自我报告的疗效。采用单因素和无序多项逻辑回归分析来评估影响参与治疗决策和自我报告疗效的因素。
我们纳入了4533例晚期CRC患者。诊断时的平均年龄为58.7±11.8岁。对于治疗方法，32.4%的患者接受手术联合化疗，13.1%的患者接受手术联合化疗和靶向治疗，9.7%的患者仅接受手术治疗。对于治疗决策，7.0%的患者完全负责决策，47.0%的患者与家庭成员共同做出治疗决策，19.0%的患者由家庭成员完全负责治疗决策，27.0%的患者由医生完全负责治疗决策。性别、年龄、教育水平、家庭收入、婚姻状况、治疗费用、医院类型和治疗方法与患者参与治疗决策显著相关。共有3824例患者在治疗期间提交了自我报告的疗效评估。自我报告疗效良好的患者比例分别为76.5%（首次治疗的患者）、61.7%（第二次治疗的患者）和43.2%（复发和转移后治疗的患者）。职业、教育水平、家庭年均收入、居住地、癌症诊断后的时间、医院类型、临床分期、靶向治疗以及参与治疗决策是治疗自我报告疗效的主要影响因素。
总之，CRC患者在治疗决策中并非高度主导，更有可能与家人和医生共同做出治疗决策。医生与患者之间及时有效的沟通可以增强患者参与治疗决策的程度。
