实施决策支持工具后的生存率,以促进基于证据的癌症治疗
Rohit P Ojha1, Yan Lu1, Kalyani Narra2
1Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX.
JCO clinical cancer informatics
|June 21, 2023
概括
实施用于癌症治疗的决策支持工具 (DST) 对患者整体存活率 (OS) 的影响很小. 在DST之前高度遵守基于证据的建议可能解释了对生存结果的名义影响.
科学领域:
- 在瘤学瘤学.
- 医疗保健服务研究 医疗服务研究
- 临床信息学 临床信息学
背景情况:
- 医疗保健中越来越多地采用决策支持工具 (DST),以指导基于证据的癌症治疗.
- 虽然DST可能会改善过程结果,但它们对患者存活率的影响仍然基本上是未知的.
- 这项研究调查了DST实施对乳腺癌,结肠直肠癌和肺癌患者整体生存期 (OS) 的影响.
研究的目的:
- 评估实施癌症治疗决策支持工具对整体存活率 (OS) 的影响.
- 评估DST实施后患有乳腺癌,结肠直肠癌和肺癌的患者的生存结果.
主要方法:
- 使用机构癌症注册数据模拟了一项具有历史比较的单臂试验.
- 包括在2013年12月至2017年12月期间被诊断患有第一次原发性乳腺癌,结肠直肠癌或肺癌的成年患者.
- 灵活的参数模型估计了3年受限平均生存时间 (RMST) 差异和死亡风险比率 (RR).
主要成果:
- 这项研究包括1,059名癌症患者;323名乳腺癌患者,318名结直肠癌患者,418名肺癌患者.
- DST的实施表明,它对癌症类型的3年整体存活率产生了名义上的影响.
- 肺癌患者的生存率差异最大,但不显著 (RMST: 1.7 个月;RR: 0.95).
- 对治疗建议的坚持超过了实施前70%和实施后90%.
结论:
- 实施用于癌症治疗的DST对整体存活率产生了名义影响.
- 对基于证据的建议的高度先前遵守可能已经减弱了DST所观察到的影响.
- 改善的过程结果并不总是转化为在某些医疗保健环境中改善患者生存结果.
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