Street R L, Voigt B
Department of Speech Communication, Texas A&M University, College Station 77843-4234, USA.
Med Decis Making. 1997 Jul-Sep;17(3):298-306. doi: 10.1177/0272989X9701700306.
This investigation of patients with early breast cancer examined relationships among patient involvement in deciding treatment (i.e., whether to undergo breast removal or breast conservation), perceptions of control over treatment decisions, and subsequent health-related quality of life. It was predicted 1) that patients who more actively participated in consultations to decide treatment would perceive more decision control than would more passive patients and 2) that patients who perceived greater decision control would report better health-related quality of life following treatment than would patients perceiving less decision control. Sixty patients with stage I or II breast cancer allowed their consultations with surgeons to be audiorecorded. Following these visits, patients reported on their involvement in the consultation, optimism for the future, knowledge about treatment, and two aspects of perceived decision control, the perception of having a choice for treatment and the extent to which the doctor or patient was responsible for the decision. Six and 12 months postoperatively, 51 patients (85%) returned a follow-up survey assessing perceived decision control and health-related quality of life. The first prediction received some support. The patients who had more actively participated in their consultations, particularly in terms of offering opinions, assumed more responsibility for treatment decisions during the year following surgery than did less expressive patients. Also, the patients who reported more involvement in their consultations later believed they had had more of a choice for treatment. The second hypothesis was partially supported. Six and 12 months following treatment, the patients who believed they were more responsible for treatment decisions and believed they had more choice of treatment reported higher levels of quality of life than did the patients who perceived themselves to have less decision control. However, perceived control at the time of treatment did not predict later quality of life. Theoretical and clinical implications are discussed.
这项针对早期乳腺癌患者的调查研究了患者在决定治疗方案（即是否进行乳房切除或保乳治疗）过程中的参与度、对治疗决策的控制感以及随后与健康相关的生活质量之间的关系。研究预测：1）更积极参与治疗决策咨询的患者比更消极的患者会感受到更多的决策控制权；2）与认为决策控制权较小的患者相比，认为决策控制权较大的患者在治疗后报告的与健康相关的生活质量会更好。60例I期或II期乳腺癌患者允许对他们与外科医生的会诊进行录音。会诊后，患者报告了他们在会诊中的参与情况、对未来的乐观程度、对治疗的了解以及决策控制感的两个方面，即对治疗选择的感知以及医生或患者对决策负责的程度。术后6个月和12个月，51名患者（85%）返回了一份后续调查问卷，评估决策控制感和与健康相关的生活质量。第一个预测得到了一些支持。在会诊中更积极参与的患者，特别是在提出意见方面，在术后一年中比表达较少的患者对治疗决策承担了更多责任。此外，后来报告在会诊中参与度更高的患者认为他们在治疗上有更多选择。第二个假设得到了部分支持。治疗后6个月和12个月，认为自己对治疗决策更负责且认为有更多治疗选择的患者报告的生活质量水平高于认为自己决策控制权较小的患者。然而，治疗时的控制感并不能预测后期的生活质量。本文讨论了其理论和临床意义。
