背景:癌症患者正面临各种治疗和其他疾病相关的决定。这项研究旨在使用德国癌症信息服务(CIS)提供有关不同肿瘤患者在决策中的首选和感知参与角色的见解。
方法:患者的决策偏好和经验被评估为CIS使用者横断面调查的一部分。控制偏好量表(CPS)的改编版本用于评估八个不同医疗决策领域中的首选和感知参与角色(例如,药物的选择,终止治疗)。Logistic回归分析用于探索偏好匹配并分析参与角色与社会人口统计学变量之间的关联。此外,我们研究了不同决策情况下参与角色的偏好和看法。
结果:在最终样本中(N=1566,64.9%的女性,平均年龄=61.6),几乎一半的患者(47.1%)更愿意在决定治疗方法时发挥协作作用,而36.3%的人更喜欢主动角色,15.9%的人更喜欢被动角色。协作角色偏好(40.7%)经常与被动角色同时发生,并预测偏好和经验之间匹配的机会减少(OR=0.57,p=.001)。较高的教育水平与较低的偏好和感知被动角色的机会相关(OR=0.85,p<.01)。和男人相比,女性更喜欢(OR=1.45,p<.05)和实际(OR=2.04,p<.001)在医疗中扮演被动角色的几率增加.关于治疗方法的优先参与角色与所有其他决策领域的偏好高度相关(r>.50,p<.001),除了关于家庭参与的决策。
结论:该研究揭示了在以高度信息寻求行为为特征的CIS用户样本中,在医疗决策的不同领域中,患者协作角色偏好的实现存在众所周知的缺陷。参与角色不仅受患者的教育水平影响,还受其性别影响。性别效应可能比以前的研究更明显。在制定促进共同决策的干预措施时应考虑到这些影响。此外,研究结果表明,参与治疗方法决策的偏好,根据CPS的评估,可以推广到医疗决策的其他领域。
BACKGROUND: Cancer patients are facing a variety of treatment and other disease-related decisions. This study aims to provide insights into preferred and perceived participation roles in decision-making among patients with diverse tumors using the German Cancer Information Service (CIS).
METHODS: Patients\' decision-making preferences and experiences were assessed as a part of a cross-sectional survey among CIS users. An adapted version of the Control Preferences Scale (CPS) was used to assess preferred and perceived participation roles in eight different areas of medical decision-making (e.g., choice of medication, termination of treatment). Logistic regression analyses were applied to explore preference matching and to analyze associations between participation roles and sociodemographic variables. Moreover, we examined preferences and perceptions of participation roles across different decision situations.
RESULTS: In the final sample (N = 1566, 64.9% female, mean age = 61.6), almost half of the patients (47.1%) preferred to take a collaborative role in decisions on treatment methods, whereas 36.3% preferred an active role and 15.9% a passive role. Collaborative role preferences frequently (40.7%) coincided with experiencing a passive role and predicted a reduced chance of a match between preferences and experiences (OR = 0.57, p = .001). A higher level of education was associated with a lower chance of preferring and perceiving a passive role (OR = 0.85, p < .01). Compared with men, women had increased odds of preferring (OR = 1.45, p < .05) and of actually taking (OR = 2.04, p < .001) a passive role in medical encounters. Preferred participation roles regarding treatment methods were highly correlated with preferences in all other decision areas (r > .50, p < .001) except decisions about family involvement.
CONCLUSIONS: The study reveals well-known deficits in the fulfilment of patients\' collaborative role preferences across different areas of medical decision-making in a sample of CIS users characterized by high information-seeking behavior. Participation roles were not only influenced by the patients\' level of education but also by their gender. The gender effect may be more pronounced than previous studies suggest. These effects should be considered in the development of interventions to promote shared decision-making. Additionally, study results indicate that preferences for participation in decisions about treatment methods, as assessed by the CPS, can be generalized to other areas of medical decision-making.