侧重于生命的抗癌治疗篮球运动员分享了晚期癌症患者的决策：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
影响因子:3.90000
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
摘要
在肿瘤学实践中实施共同的决策通常受到限制，尤其是将患者的环境纳入决策。为了改善这一点，我们进行了一个质量改进项目。上下文试图通过以下方式来实现这一目标：（1）在与医学肿瘤学家协商期间将患者的上下文集成到共同的决策中； （2）积极参与GP和病例经理（专业的肿瘤护士），他们经常对患者的情况有所了解，并且； （3）为患有晚期癌症患者提供长达2周的时间段时间，以与其他人（包括亲密的家人和朋友）考虑和讨论治疗选择。探索在引入上下文后如何在引入上下文后经历了共同的决策。一种定性嵌入性的多重疗法研究，使用对每种案例的典范分析的深入访谈。确定了四个主题：共同的决策是一个动态且连续的过程（1），其中医学肿瘤学家的治疗建议是中心的（2），这是由于患者没有选择的经验而推动的（3），并且将患者的上下文整合到共同的决策中，并认为重要的是，在医学阶段（4）与终结阶段相关。生命的抗癌治疗限制了共同决策的潜力。这破坏了将个人环境纳入决策，这是姑息治疗连续体的关键方面。
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.