Bechthold Avery C, Azuero Andres, Puga Frank, Ejem Deborah B, Kent Erin E, Ornstein Katherine A, Ladores Sigrid L, Wilson Christina M, Knoepke Christopher E, Miller-Sonet Ellen, Odom J Nicholas
School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
Cancers (Basel). 2023 Sep 29;15(19):4792. doi: 10.3390/cancers15194792.
Prioritizing patient values-who/what matters most-is central to palliative care and critical to treatment decision making. Yet which factors are most important to family caregivers in these decisions remains understudied. Using data from a U.S. national survey of cancer caregivers (N = 1661), we examined differences in factors considered very important by caregivers when partnering with patients in cancer treatment decision making by cancer stage and caregiver sociodemographics. Fifteen factors were rated on a 4-point Likert-scale from 'very unimportant' to 'very important.' Descriptive statistics were used to characterize caregiver factors and tabulate proportions of importance for each. Generalized linear mixed effect modeling was used to examine the importance of factors by cancer stage, and chi-square analyses were performed to determine associations between caregiver sociodemographics and the five most commonly endorsed factors: quality of life (69%), physical well-being (68%), length of life (66%), emotional well-being (63%), and opinions/feelings of oncology team (59%). Significant associations (all 's < 0.05) of small magnitude were found between the most endorsed factors and caregiver age, race, gender, and ethnicity, most especially 'opinions/feelings of the oncology team'. Future work is needed to determine the best timing and approach for eliciting and effectively incorporating caregiver values and preferences into shared treatment decision making.
将患者价值观（谁/什么最重要）置于优先地位是姑息治疗的核心，也是治疗决策的关键。然而，在这些决策中，哪些因素对家庭照顾者最为重要，仍有待深入研究。利用美国一项针对癌症照顾者的全国性调查数据（N = 1661），我们研究了在癌症治疗决策中，照顾者与患者合作时，根据癌症阶段和照顾者社会人口统计学特征，认为非常重要的因素之间的差异。15个因素按照从“非常不重要”到“非常重要”的4点李克特量表进行评分。描述性统计用于描述照顾者因素，并列出每个因素的重要性比例。广义线性混合效应模型用于研究各因素在不同癌症阶段的重要性，卡方分析用于确定照顾者社会人口统计学特征与五个最常被认可的因素之间的关联：生活质量（69%）、身体健康（68%）、寿命长度（66%）、情绪健康（63%）以及肿瘤团队的意见/感受（59%）。在最常被认可的因素与照顾者年龄、种族、性别和民族之间发现了小幅度的显著关联（所有p值<0.05），尤其是“肿瘤团队的意见/感受”。未来需要开展工作，以确定在共同治疗决策中引出并有效纳入照顾者价值观和偏好的最佳时机和方法。
