Whelan T J, Levine M N, Gafni A, Lukka H, Mohide E A, Patel M, Streiner D L
Ontario Cancer Treatment and Research Foundation-Hamilton Regional Cancer Center, Division of Radiation Oncology, Ontario, Canada.
J Clin Oncol. 1995 Apr;13(4):847-53. doi: 10.1200/JCO.1995.13.4.847.
To develop an instrument to help clinicians inform patients about the benefits and risks of breast irradiation following lumpectomy and to help an informed patient decide whether she prefers this treatment.
A Decision Board consisting of written material and visual aids was developed. It provides the patient with detailed information about her choices (breast irradiation or not), outcomes (breast recurrence and survival), probability of those outcomes, and quality of life associated with treatment and outcome. We studied the decision-making process in 82 consecutive node-negative lumpectomy patients who were seen in consultation by a radiation oncologist and oncology nurse. The Decision Board was used in the last 30 patients in the cohort.
Patient comprehension following the consultation without the Decision Board was greater than 65% for all questions addressed, except for poor understanding of the lack of survival benefit associated with breast irradiation (12% of patients answered correctly) and that it could not be repeated (15% of patients answered correctly). Comprehension following the consultation with the Decision Board was similar, but understanding regarding the repetition of radiation (83%) was improved. Only 70% of patients in the no-Decision Board group felt they were offered a choice. This was increased to 97% in the Decision-Board group. Overall, 95% of patients chose breast irradiation, and this did not differ between groups. Patients reported several reasons for choosing breast irradiation, all of equal importance.
The Decision Board facilitated shared decision making in node-negative lumpectomy patients who chose breast irradiation, but it did not affect a patient's choice to select breast irradiation.
研发一种工具，以帮助临床医生向患者告知保乳手术后乳房放疗的益处和风险，并帮助患者在充分知情的情况下决定是否选择这种治疗方法。
开发了一个由书面材料和视觉辅助工具组成的决策板。它为患者提供了有关其选择（是否进行乳房放疗）、结果（乳房复发和生存率）、这些结果的概率以及与治疗和结果相关的生活质量的详细信息。我们研究了82例连续的腋窝淋巴结阴性保乳手术患者的决策过程，这些患者由放射肿瘤学家和肿瘤学护士会诊。该决策板用于该队列中的最后30例患者。
在没有决策板的会诊后，除了对乳房放疗缺乏生存益处（12%的患者回答正确）以及放疗不能重复（15%的患者回答正确）理解较差外，所有问题的患者理解率均超过65%。使用决策板会诊后的理解情况相似，但对放疗可重复性的理解（83%）有所改善。在没有决策板的组中，只有70%的患者认为他们有选择的机会。在决策板组中，这一比例提高到了97%。总体而言，95%的患者选择了乳房放疗，两组之间没有差异。患者报告了选择乳房放疗的几个原因，所有原因同等重要。
决策板有助于腋窝淋巴结阴性保乳手术且选择乳房放疗的患者进行共同决策，但它并未影响患者选择乳房放疗的决定。
