关于息性癌症治疗的共同决策的潜在不良结果:随机试验的二次分析
Loïs F van de Water1,2,3,4, Danique W Bos-van den Hoek1,3,4, Steven C Kuijper2,4
1Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
概括
在晚期癌症治疗中,共享决策 (SDM) 与患者的紧张和不确定性增加有关. 在SDM的瘤学家培训没有减轻这些不良结果,需要进一步的研究,以尽量减少患者负担.
科学领域:
- 在瘤学瘤学.
- 患者为中心的护理
- 临床沟通 临床沟通
背景情况:
- 建议共享决策 (SDM) 为道德和结果带来好处.
- 然而,SDM可能对患有无法治愈的癌症的患者构成风险,可能导致不良影响.
- 这项研究研究了SDM与晚期癌症患者负面结局之间的关联.
研究的目的:
- 探索共享决策 (SDM) 和瘤学家SDM培训是否与晚期癌症患者的不良结果有关.
- 确定与负面患者体验相关的特定SDM元素,如焦虑,紧张,无助,决策不确定性和战斗精神下降.
主要方法:
- 一项随机临床试验的二次分析,涉及194名患者和31名瘤学家.
- 利用观察到的SDM (OPTION12) 和特定的SDM元素 (4SDM) 来评估与不良结果的关系.
- 采用多变量和单变量回归分析来建模不良结果.
主要成果:
- 观察到的SDM增加与患者更高的紧张和决策不确定性相关,在咨询后一周.
- SDM元素"告知选项"与增加的无助感/绝望感和紧张感特别相关.
- 瘤学家SDM培训与患者不良结果之间没有发现显著的关联,也没有发现长期不良影响.
结论:
- 瘤学家应该意识到,SDM可能会在一些晚期癌症患者中暂时引起负面情绪.
- 进一步的研究对于了解SDM中何时以及如何出现不良结果的细微差别至关重要.
- 研究在SDM期间尽量减少潜在患者负担的方法是必不可少的.
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