Flood Emuella, McCutcheon Susan, Beusterien Kathleen, Mackie deMauri S, Mokiou Stella, Guillaume Xavier, Mulvihill Emily
Patient Centered Science, AstraZeneca, Gaithersburg, MD, USA.
Global Medical Affairs, AstraZeneca, Cambridge, UK.
Patient Prefer Adherence. 2024 Jul 25;18:1517-1530. doi: 10.2147/PPA.S450316. eCollection 2024.
Patients with early breast cancer (eBC) are increasingly provided with different options, which may involve a sequence of different treatments and treatment modalities, and eligibility for certain adjuvant treatments depending upon pre-surgical and surgical outcomes. This study examined patient preferences around aspects of treatment decision-making in eBC.
A total of 452 patients with self-reported eBC in Germany (n=151), Italy (n=151), and Japan (n=150) completed an online survey about physician interactions and treatment side effects. The survey included best-worst scaling (BWS) to assess prioritization of 13 statements reflecting aspects of treatment decision-making. In a series of choice tasks, participants chose their most and least preferred options among subsets of 4 statements. Hierarchical Bayesian modeling was used to estimate BWS preference scores for each statement. BWS scores were based on the number of times a statement was chosen as most versus least preferred; scores total 100 for each patient.
The most preferred aspects of treatment decision-making were "treatment aggressiveness matches personal risk" (mean BWS score = 13.49), "being told about what is coming" (13.18), deciding based on "own surgical outcome" (11.90), "avoiding unnecessary treatment" (10.35), and "involving in treatment decisions" (9.44). The least preferred aspects were "not being asked about treatment decisions along the way" (3.27) and "receiving the same treatment as other patients" (3.41). Patients in Japan preferred "being told about what is coming", "deciding based on own surgical outcome", "avoiding unnecessary treatment", and being "involved in decisions" more than patients in Italy and Germany. Patients in Germany were more satisfied with their physician interactions and care, although their outcomes were not always better than those in Italy and Japan.
Patients value individualized treatment tailored to their risk of recurrence and tolerance of side effects, highlighting the need for focused patient education about options, to encourage their engagement.
早期乳腺癌（eBC）患者可选择的治疗方案越来越多，这可能涉及一系列不同的治疗方法和治疗方式，并且某些辅助治疗的适用性取决于手术前和手术的结果。本研究调查了eBC患者在治疗决策方面的偏好。
德国（n = 151）、意大利（n = 151）和日本（n = 150）的452例自我报告为eBC的患者完成了一项关于医生互动和治疗副作用的在线调查。该调查包括最佳-最差尺度法（BWS），以评估反映治疗决策方面的13条陈述的优先级。在一系列选择任务中，参与者从4条陈述的子集中选择他们最喜欢和最不喜欢的选项。采用分层贝叶斯模型估计每条陈述的BWS偏好分数。BWS分数基于一条陈述被选为最喜欢与最不喜欢的次数；每位患者的分数总计为100分。
治疗决策中最受青睐的方面是“治疗强度与个人风险相匹配”（平均BWS分数 = 13.49）、“被告知接下来会发生什么”（13.18）、根据“自身手术结果”做决定（11.90）、“避免不必要的治疗”（10.35）以及“参与治疗决策”（9.44）。最不受欢迎的方面是“在治疗过程中未被询问治疗决策”（3.27）和“接受与其他患者相同的治疗”（3.41）。与意大利和德国的患者相比，日本患者更倾向于“被告知接下来会发生什么”、“根据自身手术结果做决定”、“避免不必要的治疗”以及“参与决策”。德国患者对医生的互动和护理更满意，尽管他们的治疗结果并不总是比意大利和日本的患者更好。
患者重视根据其复发风险和副作用耐受性量身定制的个体化治疗，这突出了针对治疗方案对患者进行重点教育以鼓励他们参与的必要性。
