背景:实施精准医学很可能对临床癌症护理产生巨大影响,而医患关系是癌症治疗的一个关键方面,需要保留。本系统综述旨在阐明有关实施精准医疗将如何影响癌症护理中的医患关系的看法和担忧,以便解决对医患关系的威胁。
方法:电子数据库(Pubmed,Scopus,WebofScience,社会科学高级合集)搜索了2010年1月至2021年12月发表的文章,包括定性,定量,和理论方法。两名审稿人完成了标题和摘要筛选,全文筛选,和数据提取。使用叙事综合对研究结果进行了总结和解释。
结果:从所包含的文章中产生了四个主题(n=35)。提供信息解决了信息传输和需求的问题,以及复杂的概念,如遗传学和不确定性。在信任关系中做出决定解决了不透明问题,信任的作用,以及医生对精准医学工具在决策中的作用的态度。管理不合格患者的负面反应可解决患者对精准医疗的未满足期望。在临床和研究之间模糊的界限中,相互冲突的角色解决了医生作为医生和研究人员的双重角色所产生的问题。
结论:许多发现以前已经在医患沟通和临床遗传学中得到了解决。然而,精准医学增加了这些领域的复杂性,并进一步强调了在特定主题上进行清晰交流的重要性,例如基因组和基因表达之间的区别以及患者对获取的期望,资格,有效性,和靶向治疗的副作用。
The implementation of precision medicine is likely to have a huge impact on clinical cancer care, while the doctor-patient relationship is a crucial aspect of cancer care that needs to be preserved. This systematic review aimed to map out perceptions and concerns regarding how the implementation of precision medicine will impact the doctor-patient relationship in cancer care so that threats against the doctor-patient relationship can be addressed.
Electronic databases (Pubmed, Scopus, Web of Science, Social Science Premium Collection) were searched for articles published from January 2010 to December 2021, including qualitative, quantitative, and theoretical methods. Two reviewers completed title and abstract screening, full-text screening, and data extraction. Findings were summarized and explained using narrative synthesis.
Four themes were generated from the included articles (n = 35). Providing information addresses issues of information transmission and needs, and of complex concepts such as genetics and uncertainty. Making decisions in a trustful relationship addresses opacity issues, the role of trust, and and physicians\' attitude towards the role of precision medicine tools in decision-making. Managing negative reactions of non-eligible patients addresses patients\' unmet expectations of precision medicine. Conflicting roles in the blurry line between clinic and research addresses issues stemming from physicians\' double role as doctors and researchers.
Many findings have previously been addressed in doctor-patient communication and clinical genetics. However, precision medicine adds complexity to these fields and further emphasizes the importance of clear communication on specific themes like the distinction between genomic and gene expression and patients\' expectations about access, eligibility, effectiveness, and side effects of targeted therapies.