Butow P N, Maclean M, Dunn S M, Tattersall M H, Boyer M J
Department of Medicine, University of Sydney, New South Wales, Australia.
Ann Oncol. 1997 Sep;8(9):857-63. doi: 10.1023/a:1008284006045.
While the importance of providing individualised communication to cancer patients is now well recognised, little is known about the stability and validity of patients' expressed preferences for information and involvement in decision-making. This study explored the stability and possible predictors of such preferences over time.
Cancer patients seeing two Medical Oncologists in an out-patient clinic at an Australian teaching hospital completed a questionnaire battery before and directly after one consultation, and before their next consultation. Eighty consecutive patients with heterogeneous cancers participated in the study. Preferences for general and specific information, involvement and support were elicited at each assessment. Locus of control and patient familiarity with the clinic were measured before the first consultation. Patient satisfaction with the consultation was assessed directly after the consultation. Demographic and disease data were recorded for each patient.
General preferences for information and involvement were relatively stable, at least in the short term; however there was considerable variability in preferences for specific topics of information. Patients whose condition had recently worsened were more likely to want progressively less involvement in decision-making. Gender, the doctor seen and religion were also predictive of patient preferences.
Situational factors, such as change in disease status, may alter a patient's preferences for information and involvement. If we wish to match the provision of information and support to the expressed needs of patients, we must ask patients at each consultation what those needs are.
虽然现在人们已经充分认识到为癌症患者提供个性化沟通的重要性，但对于患者表达的信息偏好和参与决策的稳定性及有效性却知之甚少。本研究探讨了这些偏好随时间的稳定性及可能的预测因素。
在澳大利亚一家教学医院门诊就诊并会见两位肿瘤内科医生的癌症患者，在一次会诊前、会诊刚结束后以及下次会诊前完成了一系列问卷。连续80例患有不同类型癌症的患者参与了该研究。每次评估时都要了解患者对一般和特定信息、参与及支持的偏好。在首次会诊前测量患者的控制点和对诊所的熟悉程度。会诊刚结束后评估患者对会诊的满意度。记录每位患者的人口统计学和疾病数据。
对信息和参与的总体偏好相对稳定，至少在短期内如此；然而，对特定信息主题的偏好存在相当大的差异。病情近期恶化的患者越来越不愿意参与决策。性别、所看的医生和宗教信仰也可预测患者的偏好。
诸如疾病状况变化等情境因素可能会改变患者对信息和参与的偏好。如果我们希望使信息和支持的提供与患者表达的需求相匹配，就必须在每次会诊时询问患者这些需求是什么。
