关注延长生命的抗癌治疗阻碍晚期癌症患者的共同决策：一项定性嵌入式多案例研究
The focus on life-prolonging anticancer treatment hampers shared decision-making in people with advanced cancer: A qualitative embedded multiple-case study
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影响因子:3.9
分区:医学2区 / 卫生保健与服务2区 医学：内科2区 公共卫生、环境卫生与职业卫生2区
发表日期:2024 Dec
作者:
Daisy Jm Ermers, Maartje J van Geel, Yvonne Engels, Demi Kellenaers, Anouk Sj Schuurmans, Floortje K Ploos van Amstel, Carla Ml van Herpen, Yvonne Schoon, Henk J Schers, Kris Cp Vissers, Evelien Jm Kuip, Marieke Perry
DOI:
10.1177/02692163241281145
摘要
在肿瘤学实践中实施共同决策往往受限，尤其是在将患者的背景融入决策过程方面。为此，我们开展了一项质量改进项目，CONtext。CONtext试图通过以下方式实现这一目标：(1) 在与肿瘤科医生咨询时，将患者背景融入共同决策；(2) 积极 involving 一般科医生（GP）和病例管理者（专科肿瘤护士），他们通常了解患者的背景；(3) 为晚期癌症患者提供长达2周的暂停期，以考虑和讨论治疗方案，包括与亲密家人和朋友商议。旨在探讨引入CONtext后，晚期癌症患者及其相关专业人员对共同决策的体验。采用深入访谈的定性嵌入式多案例研究，通过归纳内容分析进行分析。采用目的采样共14个案例，每个案例包括一名晚期癌症患者及其理想的伴随医疗肿瘤科医生、病例管理者和GP。分析识别出四个主题：一、共同决策是一个动态且持续的过程；二、其中肿瘤科医生的治疗建议居中；三、患者体验到缺乏选择的感觉，成为推动因素；四、将患者背景融入共同决策被认为重要但受到阻碍，例如与终末期相关联。肿瘤科医生和晚期癌症患者普遍优先考虑延长生命的抗癌治疗，这限制了共同决策的潜力。这削弱了将个体背景融入决策的能力，这是姑息治疗连续性中的关键环节。
Abstract
Implementing shared decision-making in oncology practice is often limited, particularly integrating the patient's context into decision-making. To improve this, we conducted a quality improvement project, CONtext. CONtext attempts to accomplish this by: (1) Integrating the patient's context into shared decision-making during consultation with the medical oncologist; (2) Actively involving the GP and case manager (a specialized oncology nurse), who often have knowledge about the patient's context, and; (3) Giving the person with advanced cancer a time-out period of up to 2 weeks to consider and discuss treatment options with others, including close family and friends.To explore how persons with advanced cancer and their involved professionals experienced shared decision-making after the introduction of CONtext.A qualitative embedded multiple-case study using in-depth interviews analysed with inductive content analysis.A purposive sample of 14 cases, each case consisting of a patient with advanced cancer and ideally their medical oncologist, case manager, and GP.Four themes were identified: shared decision-making is a dynamic and continuous process (1), in which the medical oncologist's treatment recommendation is central (2), fuelled by the patients' experience of not having a choice (3), and integrating the patient's context into shared decision-making was considered important but hampered (4), for example, by the association with the terminal phase.The prevailing tendency among medical oncologists and persons with advanced cancer to prioritize life-prolonging anticancer treatments restricts the potential for shared decision-making. This undermines integrating individual context into decision-making, a critical aspect of the palliative care continuum.