预后沟通策略对晚期癌症患者预后认知、治疗决策和临终预期的影响：一项模拟患者的实验研究。
Effects of Prognostic Communication Strategies on Prognostic Perceptions, Treatment Decisions and End-Of-Life Anticipation in Advanced Cancer: An Experimental Study among Analogue Patients.
机构信息
Department of Medical Psychology (N.C.A.V., E.M.A.S., I.H.), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health (N.C.A.V., E.M.A.S., I.H.), Quality of Care, Amsterdam, The Netherlands; Cancer Center Amsterdam (N.C.A.V., E.M.A.S., I.H., H.W.M.L.), Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
Department of Medical Psychology (N.C.A.V., E.M.A.S., I.H.), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health (N.C.A.V., E.M.A.S., I.H.), Quality of Care, Amsterdam, The Netherlands; Cancer Center Amsterdam (N.C.A.V., E.M.A.S., I.H., H.W.M.L.), Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
出版信息
J Pain Symptom Manage. 2024 Jun;67(6):478-489.e13. doi: 10.1016/j.jpainsymman.2024.02.563. Epub 2024 Feb 29.
CONTEXT
Evidence-based guidance for oncologists on how to communicate prognosis is scarce.
OBJECTIVES
To investigate the effects of prognostic communication strategies (prognostic disclosure vs. communication of unpredictability vs. non-disclosure; standard vs. standard and best-case vs. standard, best- and worst-case survival scenarios; numerical vs. word-based estimates) on prognostic perceptions, treatment decision-making and end-of-life anticipation in advanced cancer.
METHODS
This experimental study used eight videos of a scripted oncological consultation, varying only in prognostic communication strategies. Cancer-naive individuals, who imagined being the depicted patient, completed surveys before and after watching one video (n = 1036).
RESULTS
Individuals generally perceived dying within 1 year as more likely after prognostic disclosure, compared to communication of unpredictability or non-disclosure (P < 0.001), and after numerical versus word-based estimates (P < 0.001). Individuals felt better informed about prognosis to decide about treatment after prognostic disclosure, compared to communication of unpredictability or non-disclosure (P < 0.001); after communication of unpredictability versus non-disclosure (P < 0.001); and after numerical versus word-based estimates (P = 0.017). Chemotherapy was more often favored after prognostic disclosure versus non-disclosure (P = 0.010), but less often after numerical versus word-based estimates (P < 0.001). Individuals felt more certain about the treatment decision after prognostic disclosure, compared to communication of unpredictability or non-disclosure (P < 0.001). Effects of different survival scenarios were absent. No effects on end-of-life anticipation were observed. Evidence for moderating individual characteristics was limited.
CONCLUSION
If and how oncologists discuss prognosis can influence how individuals perceive prognosis, which treatment they prefer, and how they feel about treatment decisions. Communicating numerical estimates may stimulate prognostic understanding and informed treatment decision-making.
背景
肿瘤学家在如何进行预后沟通方面缺乏循证指导。
目的
研究预后沟通策略（预后告知与不可预测性告知或不告知；标准与标准加最佳和最差情况生存预测值、标准、最佳和最差情况生存预测值；数字与文字估计）对晚期癌症患者的预后感知、治疗决策和临终预期的影响。
方法
本实验性研究使用了 8 个脚本化肿瘤学咨询视频，仅在预后沟通策略上有所不同。癌症患者在观看一个视频前后完成了调查（n=1036）。
结果
与不可预测性告知或不告知相比（P<0.001），与文字估计相比（P<0.001），告知预后时，患者普遍认为在 1 年内死亡的可能性更大。与不可预测性告知或不告知相比（P<0.001）；与不可预测性告知相比（P<0.001）；与文字估计相比（P=0.017），患者在预后告知后，感觉对预后有更好的了解，更能决定治疗。与不告知相比（P=0.010），但与文字估计相比（P<0.001），告知预后时，更倾向于化疗。与不可预测性告知或不告知相比（P<0.001），患者在预后告知后，对治疗决策更有信心。不同生存预测值对预后感知的影响不明显。对临终预期没有影响。个体特征的调节作用证据有限。
结论
如果肿瘤医生讨论预后，以及如何讨论，可能会影响患者对预后的感知、他们对治疗的偏好，以及他们对治疗决策的感受。沟通数字估计可能会刺激对预后的理解和知情的治疗决策。
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