Moyer A, Salovey P
Center for Biomedical Ethics, Stanford University.
Womens Health. 1998 Summer;4(2):103-16.
Women in the early stages of breast cancer can be treated effectively with either modified radical mastectomy or tumor excision plus postoperative radiation therapy. Thus, breast cancer patients may be given a choice between these two modes of treatment. In some states, physician disclosure of such treatment alternatives for breast cancer is mandated by law. Despite the belief that patient participation in decision making is beneficial, the evidence is preliminary, although generally supportive. This study examined the extent to which patient participation in the choice of surgical options was related to psychological functioning, fear of cancer recurrence, and aspects of treatment satisfaction 3 and 13 months postoperatively. Few associations with degree of participation in treatment decision making or type of surgical treatment emerged after 3 months. After 13 months, however, women with greater levels of input into their treatment plan were more satisfied with their medical care, although they were not better off in terms of psychological functioning or fear of cancer recurrence. The positive effects of shared treatment decision making may be more closely related to aspects of longer term treatment satisfaction rather than a buffer against psychological distress resulting from breast cancer.
处于乳腺癌早期阶段的女性可以通过改良根治性乳房切除术或肿瘤切除加术后放射治疗得到有效治疗。因此，乳腺癌患者可以在这两种治疗方式之间做出选择。在某些州，法律规定医生必须向患者披露乳腺癌的此类治疗选择。尽管人们认为患者参与决策是有益的，但证据是初步的，不过总体上是支持这一观点的。本研究调查了患者参与手术方案选择的程度与术后3个月和13个月时的心理功能、对癌症复发的恐惧以及治疗满意度各方面之间的关联。术后3个月时，与参与治疗决策的程度或手术治疗类型几乎没有关联。然而，术后13个月时，对治疗方案投入程度较高的女性对医疗护理更满意，尽管她们在心理功能或对癌症复发的恐惧方面并没有更好。共同参与治疗决策的积极效果可能与长期治疗满意度的各方面更密切相关，而不是作为抵御乳腺癌所致心理困扰的缓冲。
