肿瘤科医生性别、参与性决策、焦虑与乳腺癌护理的关系

Allyson J. Weseley, Kevin Xu
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摘要

乳房肿瘤切除术后的辅助治疗(化疗和放疗)有助于提高生存率的发现是现代乳腺癌治疗的突破性发展。参与式决策(PDM)是一种医患之间积极互动和对话的沟通方式。虽然已经发现各种类型癌症的辅助治疗的接受与医患沟通的差异有关,但很少有研究探讨这种关系是否存在于乳腺癌治疗中。目前的研究是第一个明确检查可能与辅助治疗率相关的人口统计学和社会心理因素的研究之一,调查了一组市中心乳腺癌患者(N = 105),调查了他们接受的护理类型,评估了参与性决策(PDM)和焦虑的伴随水平。结果显示,PDM较高的患者往往有较低的焦虑水平(p < 0.01)。女性肿瘤医生的乳腺癌患者接受辅助治疗的可能性高于男性肿瘤医生的乳腺癌患者(p < 0.05)。与普遍的看法相反,无论医生的性别或是否接受辅助治疗,患者报告的PDM和焦虑水平相同。该样本中令人惊讶的低辅助治疗率(45%)表明乳腺癌护理中可能存在系统故障,并表明需要更多地关注公众教育,了解在乳腺癌护理中接受随访治疗的重要性。
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Relationships between Oncologist Gender, Participatory Decision Making, Anxiety and Breast Cancer Care
The discovery that adjuvant treatment (chemotherapy and radiotherapy) after lumpectomy contributes to high survival rates has been a groundbreaking development in modern breast cancer care. Participatory decision-making (PDM) is a communication style that involves active interactions and discourse between doctors and patients. Although the receipt of adjuvant therapy for various types of cancers has been found to be linked to differences in patient-physician communication, few studies have explored whether this relationship exists in breast cancer treatment. The present study, one of the first explicitly to examine demographic and psychosocial factors that may be related to adjuvant treatment rates, surveyed a sample of inner-city breast cancer patients (N = 105) about the type of care they received, assessing concomitant levels of participatory decision making (PDM), and anxiety. The results demonstrated that patients who indicated higher PDM tended to have lower levels of anxiety (p < .01). Breast cancer patients who saw female oncologists were more likely to receive adjuvant treatment than breast cancer patients who saw male oncologists (p < .05). Contrary to popular belief, patients reported equivalent levels of PDM and anxiety regardless of their physician’s gender or their receipt of adjuvant treatment. The surprisingly low adjuvant treatment rates (45%) in this sample suggest possible system failures in breast cancer care and indicate that more attention needs to be given to public education on the importance of receiving follow-up treatment in breast cancer care.
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