Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
Med Decis Making. 2024 Jan;44(1):89-101. doi: 10.1177/0272989X231208448. Epub 2023 Nov 12.
While shared decision making (SDM) is advocated for ethical reasons and beneficial outcomes, SDM might also negatively affect patients with incurable cancer. The current study explored whether SDM, and an oncologist training in SDM, are associated with adverse outcomes (i.e., patient anxiety, tension, helplessness/hopelessness, decisional uncertainty, and reduced fighting spirit).
A secondary analysis of a randomized clinical trial investigating the effects of SDM interventions in the context of advanced cancer. The relations between observed SDM (OPTION12), specific SDM elements (4SDM), oncologist SDM training, and adverse outcomes were analyzed. We modeled adverse outcomes as a multivariate phenomenon, followed by univariate regressions if significant.
In total, 194 patients consulted by 31 oncologists were included. In a multivariate analysis, observed SDM and adverse outcomes were significantly related. More specifically, more observed SDM in the consultation was related to patients reporting more tension ( = 0.002) and more decisional uncertainty ( = 0.004) at 1 wk after the consultation. The SDM element "informing about the options" was especially found to be related to adverse outcomes, specifically to more helplessness/hopelessness ( = 0.002) and more tension ( = 0.016) at 1 wk after the consultation. Whether the patient consulted an oncologist who had received SDM training or not was not significantly related to adverse outcomes. No relations with long-term adverse outcomes were found.
It is important for oncologists to realize that for some patients, SDM may temporarily be associated with negative emotions. Further research is needed to untangle which, when, and how adverse outcomes might occur and whether and how burden may be minimized for patients.
Observed shared decision making was related to more tension and uncertainty postconsultation in advanced cancer patientsHowever, training oncologists in SDM did not affect adverse outcomes.Further research is needed to untangle which, when, and how adverse outcomes might occur and how burden may be minimized.
虽然共享决策（SDM）出于伦理原因和有益结果而受到推崇，但它也可能对患有绝症的患者产生负面影响。本研究探讨了 SDM 及其在 SDM 方面受过培训的肿瘤医生是否与不良结果（即患者的焦虑、紧张、无助/绝望、决策不确定性和降低斗志）相关。
一项对随机临床试验的二次分析，该试验研究了 SDM 干预措施在晚期癌症中的影响。分析了观察到的 SDM（OPTION12）、特定的 SDM 元素（4SDM）、肿瘤医生 SDM 培训与不良结果之间的关系。我们将不良结果建模为一个多变量现象，如果显著，则进行单变量回归。
共纳入 31 名肿瘤医生为 194 名患者提供咨询。在多变量分析中，观察到的 SDM 和不良结果呈显著相关。更具体地说，咨询中更多的观察到的 SDM 与患者在咨询后 1 周报告更多的紧张（=0.002）和更多的决策不确定性（=0.004）相关。特别发现，SDM 元素“告知选择”与不良结果相关，特别是在咨询后 1 周时，患者报告更多的无助/绝望（=0.002）和更多的紧张（=0.016）。患者咨询的肿瘤医生是否接受过 SDM 培训与不良结果无关。未发现与长期不良结果相关的关系。
肿瘤医生必须意识到，对于某些患者来说，SDM 可能会暂时与负面情绪相关。需要进一步研究以理清不良结果何时、如何发生，以及是否以及如何为患者减轻负担。
在晚期癌症患者中，观察到的共享决策与咨询后更多的紧张和不确定性相关然而，培训肿瘤医生进行 SDM 并不会影响不良结果进一步的研究需要理清不良结果何时、如何发生，以及如何为患者减轻负担。
