Crawford E D, Bennett C L, Stone N N, Knight S J, DeAntoni E, Sharp L, Garnick M B, Porterfield H A
Division of Urology, University of Colorado Health Sciences Center, Denver, USA.
Urology. 1997 Sep;50(3):366-72. doi: 10.1016/s0090-4295(97)00254-9.
Prostate cancer will account for 334,500 new cases and 41,800 deaths among men in the United States in 1997. Patients and physicians are faced with many concerns related to benefits and side effects of alternative treatments, educational needs, emotional support, and costs of care. Support groups for prostate cancer patients have been established to help satisfy needs in these areas. Therefore, we addressed three issues among patients who belong to a prostate cancer support group as well as among a second group of urologists who treat prostate cancer: (1) goals for prostate cancer treatment, (2) information that is given and recalled about the disease and therapy, and (3) extent to which educational and emotional needs are being met.
Random telephone surveys were made of 1000 men with prostate cancer who belong to the prostate cancer support group US TOO, the largest prostate cancer support group in the United States, and 200 urologists who provide care to men with prostate cancer. The surveys were conducted by the Louis Harris & Associates survey research firm.
About four fifths of patients and urologists prefer aggressive therapy for prostate cancer. Patient goals with therapy included preservation of quality of life (45%), extension of life (29%), and delaying disease progression (13%), whereas physicians overwhelmingly focused on treatment efficacy (86%), with side effects (43%) and costs (29%) being secondary considerations. Urologists and patients differed markedly in the description of the patient-physician discussion. Whereas almost 100% of physicians stated that they always discussed important considerations such as options for no therapy, life expectancy with and without therapy, patient preferences, costs, and changes in sexual function, only about one fifth of patients recalled similar discussions. Patients and physicians both believed that physicians were an excellent source of educational support, but often did not report provision of emotional support. Although support groups were viewed as good providers of educational and emotional support by 85% to 90% of patients, physicians appeared to underestimate the benefit of support groups in these areas.
Patients who belong to US TOO have many emotional and educational needs that are not currently being fulfilled by physicians. Although the goals of therapy are viewed similarly by patients and physicians, much of the important cancer- and treatment-related information that physicians report they have provided is not recalled by patients. Policy makers would be wise to devise systematic strategies such as shared decision-making tools and better linkages to support groups to ensure that patients' needs are being met.
1997年在美国，前列腺癌将占男性新增病例334,500例，死亡41,800例。患者和医生面临许多与替代治疗的益处和副作用、教育需求、情感支持及护理费用相关的问题。已成立前列腺癌患者支持小组以帮助满足这些领域的需求。因此，我们探讨了属于前列腺癌支持小组的患者以及治疗前列腺癌的第二组泌尿科医生中的三个问题：（1）前列腺癌治疗的目标；（2）关于疾病和治疗所提供及回忆起的信息；（3）教育和情感需求得到满足的程度。
对属于美国最大的前列腺癌支持小组“美国也有”的1000名前列腺癌男性患者以及为前列腺癌男性患者提供护理的200名泌尿科医生进行随机电话调查。调查由路易斯·哈里斯联合调查研究公司进行。
约五分之四的患者和泌尿科医生倾向于对前列腺癌采取积极治疗。患者的治疗目标包括维持生活质量（45%）、延长生命（29%）和延缓疾病进展（13%），而医生压倒性地关注治疗效果（86%），副作用（43%）和费用（29%）是次要考虑因素。泌尿科医生和患者在对医患讨论的描述上有显著差异。几乎100%的医生表示他们总是讨论重要的考虑因素，如不治疗的选择、治疗和不治疗情况下的预期寿命、患者偏好、费用以及性功能变化，而只有约五分之一的患者回忆起类似的讨论。患者和医生都认为医生是教育支持的极佳来源，但往往未报告提供情感支持。尽管85%至90%的患者认为支持小组是教育和情感支持的良好提供者，但医生似乎低估了支持小组在这些领域的益处。
属于“美国也有”的患者有许多情感和教育需求，目前医生并未满足这些需求。尽管患者和医生对治疗目标的看法相似，但患者并未回忆起医生报告他们已提供的许多与癌症和治疗相关的重要信息。政策制定者明智的做法是制定系统策略，如共同决策工具和与支持小组建立更好的联系，以确保患者的需求得到满足。
