Rumaihi Khalid Al, Younes Nagy, Khalil Ibrahim Adnan, Badawi Alaeddin, Barah Ali, Ansari Walid El
Department of Urology, Hamad Medical Corporation, Doha, Qatar.
College of Medicine, Qatar University, Doha, Qatar.
Pan Afr Med J. 2024 Oct 18;49:45. doi: 10.11604/pamj.2024.49.45.42047. eCollection 2024.
Patient engagement and shared decision-making (SDM) between patients and clinicians is the foundation of patient-centered care. It aims to reach a treatment option that fits the patient's preference and is guideline-concordant. We sought to evaluate the possible causes and outcomes of patient's non-guideline-concordant care choices. Using a retrospective analysis of the medical records of patients who underwent cryoablation for small renal masses between January 2010 and January 2023. Inclusion criteria were patients with renal tumor(s) who underwent cryoablation which was not recommended by the multidisciplinary team (MDT). We present three patients with unilateral clear cell renal cell carcinoma. Based on imaging and other findings, the oncology MDT recommended partial/radical nephrectomy. Upon consultation, each refused surgery and preferred cryoablation. Respecting their choice, cryoablation was undertaken. The patients had treatment failure and developed recurrences that could have possibly been avoided with guideline-concordant care. Shared decision-making in healthcare involves several aspects: patient/family; uncertainty of available evidence of various treatments; MDT meetings; and treatment team. For patients to select 'wise' treatment preferences i.e. guideline-concordant care, multi-layered complex intellectual and cognitive processes are required, where experience may play a role. Healthcare professionals require guidance and training on appropriate SDM in clinical settings, and awareness of tools to solicit patient choice to guideline-concordant care whilst observing patient autonomy. Patients and treatment teams need the capacity, knowledge, and skills to reach a 'wise' guideline-concordant care treatment preference jointly. Patients' unwise preference could lead to suboptimal outcomes, in the case of our patients, tumor recurrence.
患者与临床医生之间的参与度及共同决策（SDM）是患者为中心的医疗的基础。其目的是达成一种符合患者偏好且与指南一致的治疗方案。我们试图评估患者不符合指南的治疗选择的可能原因及结果。通过对2010年1月至2023年1月间接受小肾肿瘤冷冻消融治疗的患者病历进行回顾性分析。纳入标准为患有肾肿瘤且接受了多学科团队（MDT）不推荐的冷冻消融治疗的患者。我们呈现了3例单侧透明细胞肾细胞癌患者。基于影像学及其他检查结果，肿瘤MDT建议行部分/根治性肾切除术。经咨询，每位患者均拒绝手术而倾向于冷冻消融。尊重他们的选择，实施了冷冻消融。这些患者出现了治疗失败并发生了复发，而符合指南的治疗可能避免这种情况。医疗保健中的共同决策涉及几个方面：患者/家属；各种治疗现有证据的不确定性；MDT会议；以及治疗团队。为了让患者选择“明智”的治疗偏好，即符合指南的治疗，需要多层次的复杂智力和认知过程，经验可能在其中发挥作用。医疗保健专业人员在临床环境中需要接受关于适当共同决策的指导和培训，并了解在尊重患者自主权的同时征求患者对符合指南治疗选择的工具。患者和治疗团队需要具备共同达成“明智”的符合指南治疗偏好的能力、知识和技能。患者不明智的偏好可能导致次优结果，就我们的患者而言，即肿瘤复发。
