描述临床医生与患者关于lecanemab的沟通情况：一项对七个学术医疗中心临床医生的定性研究。
Characterizing clinician communication with patients about lecanemab: A qualitative study of clinicians across seven academic medical centers.
作者信息
Parks Anna L, Thacker Ayush, Dohan Daniel, Gomez Liliana A Ramirez, Gale Seth A, Johnson Kim G, Ritchie Christine S, Shah Sachin J, Paladino Joanna
机构信息
Division of Hematology and Hematologic Malignancies University of Utah Salt Lake City Utah USA.
Mongan Institute Center for Aging and Serious Illness Massachusetts General Hospital Boston Massachusetts USA.
出版信息
Alzheimers Dement (N Y). 2025 Aug 26;11(3):e70150. doi: 10.1002/trc2.70150. eCollection 2025 Jul-Sep.
INTRODUCTION
Anti-amyloid monoclonal antibodies (mAbs) slow cognitive decline in Alzheimer's disease but may cause amyloid-related imaging abnormalities (ARIA), which can rarely be disabling or fatal. This qualitative study investigates how clinicians communicate the benefits and risks of mAbs to patients and caregivers.
METHODS
Semi-structured interviews with clinicians who prescribe mAbs at seven academic medical centers. Hybrid inductive-deductive thematic analysis by interdisciplinary researchers.
RESULTS
In 27 clinician interviews (women [ = 17], White individuals [ = 19], neurologists [ = 17]), three themes emerged. First, clinicians varied in techniques used and concepts emphasized, including using analogies, discussing statistics, and emphasizing versus de-emphasizing risks. Second, patient contextual factors (e.g., comorbidities), hopes, and fears shaped communication. Third, clinician communication varied by training, personal style, and ambivalence. While clinicians honor patients' choices to pursue treatment, many do not "recommend" it (but may recommend against it).
DISCUSSION
Preliminary insights about how clinicians communicate tradeoffs can guide future shared decision-making interventions for mAbs.
HIGHLIGHTS
This qualitative study among 27 clinicians across seven academic medical centers examined how clinicians communicate with people with Alzheimer's disease about risks and benefits of anti-amyloid therapy, which can influence treatment decisions.Clinicians varied in what techniques they employed and how they portrayed risks and benefits, and whether they incorporated patients' values.They cited comorbidities, eligibility criteria fit, and degree of social support or family involvement in decisions as factors used in framing discussions, while fewer used patients' goals to guide discussion.The professional training, individual practice style, and personal sense of ambivalence of clinicians shaped conversations.These findings can guide future interventions to improve communication and shared decision-making.
引言
抗淀粉样蛋白单克隆抗体（mAb）可减缓阿尔茨海默病患者的认知衰退，但可能会引发淀粉样蛋白相关影像异常（ARIA），这种情况极少会导致残疾或致命。本定性研究旨在调查临床医生如何向患者及护理人员传达单克隆抗体的益处和风险。
方法
对七家学术医疗中心开具单克隆抗体处方的临床医生进行半结构化访谈。由跨学科研究人员进行混合归纳 - 演绎主题分析。
结果
在27次临床医生访谈中（女性[ = 17]，白人[ = 19]，神经科医生[ = 17]），出现了三个主题。首先，临床医生在使用的技巧和强调的概念方面存在差异，包括使用类比、讨论统计数据以及强调或淡化风险。其次，患者的背景因素（如合并症）、希望和恐惧影响了沟通。第三，临床医生的沟通因培训、个人风格和矛盾心理而有所不同。虽然临床医生尊重患者选择接受治疗的决定，但许多人并不“推荐”（但可能会建议反对）。
讨论
关于临床医生如何传达权衡取舍的初步见解可为未来单克隆抗体的共同决策干预提供指导。
要点
这项对七家学术医疗中心的27名临床医生进行的定性研究，考察了临床医生如何与阿尔茨海默病患者就抗淀粉样蛋白治疗的风险和益处进行沟通，这可能会影响治疗决策。临床医生在采用的技巧、描述风险和益处的方式以及是否纳入患者价值观方面存在差异。他们提到合并症、符合入选标准情况以及社会支持或家庭参与决策的程度是构建讨论时所考虑的因素，而较少使用患者目标来指导讨论。临床医生的专业培训、个人执业风格和个人矛盾心理塑造了对话。这些发现可为未来改善沟通和共同决策的干预措施提供指导。
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