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Các công cụ hỗ trợ quyết định cho liệu pháp hóa trị giảm nhẹ giai đoạn hai: một thử nghiệm đa trung tâm ngẫu nhiên pha II
Tóm tắt
Có sự công nhận ngày càng cao về sự cân bằng nhạy cảm giữa lợi ích khiêm tốn của hóa trị giảm nhẹ và gánh nặng của điều trị. Các công cụ hỗ trợ quyết định (DAs) có thể giúp bệnh nhân mắc ung thư giai đoạn tiến triển trong các quyết định điều trị khó khăn này, nhưng việc cung cấp thông tin chi tiết có thể ảnh hưởng tiêu cực đến sự an lành của bệnh nhân. Mục tiêu của nghiên cứu ngẫu nhiên pha II này là đánh giá tính an toàn và hiệu quả của các DAs cho bệnh nhân ung thư giai đoạn tiến triển đang xem xét liệu pháp hóa trị giai đoạn hai. Bệnh nhân mắc ung thư vú hoặc đại trực tràng giai đoạn tiến triển đang xem xét điều trị giai đoạn hai được phân ngẫu nhiên vào nhóm chăm sóc thông thường (nhóm đối chứng) hoặc chăm sóc thông thường cộng với DAs (nhóm can thiệp) theo tỷ lệ 1:2. Một y tá đã cung cấp DAs với thông tin về các tác dụng phụ, phản ứng khối u và sự sống còn. Các biện pháp đánh giá bao gồm sự an lành tự báo cáo của bệnh nhân (kết quả chính: lo âu) và chất lượng của quá trình ra quyết định cùng với lựa chọn kết quả. Trong số 128 bệnh nhân được phân ngẫu nhiên, 45 đã được phân vào nhóm đối chứng và 83 vào nhóm can thiệp. Tuổi trung bình là 62 tuổi (khoảng từ 32-81), 63% là nữ và 73% mắc ung thư đại trực tràng. Phần lớn bệnh nhân ưu tiên điều trị bằng hóa trị (87%) và sau đó bắt đầu điều trị bằng hóa trị (86%). Không phát hiện ảnh hưởng tiêu cực đến sự an lành của bệnh nhân và các y tá báo cáo rằng các cuộc tư vấn có cung cấp DAs diễn ra tốt. Việc được cung cấp DAs có liên quan đến sở thích điều trị mạnh mẽ hơn (3.0 so với 2.5; p=0.030) và gia tăng kiến thức chủ quan (6.7 so với 6.3; p=0.022). Kiến thức khách quan, nhận thức rủi ro và cảm nhận sự tham gia thì tương đương giữa các nhóm. Các DAs chứa thông tin rủi ro chi tiết về điều trị giảm nhẹ giai đoạn hai có thể được cung cấp cho bệnh nhân ung thư giai đoạn tiến triển mà không gây ảnh hưởng tiêu cực đến sự an lành của bệnh nhân. Ngạc nhiên thay, các DAs chỉ cải thiện một cách nhỏ chất lượng của quá trình ra quyết định. Hiệu quả của DAs đối với các quyết định điều trị giảm nhẹ cần được khám phá thêm.
Từ khóa
#ung thư #hóa trị #công cụ hỗ trợ quyết định #điều trị giảm nhẹ #lo âuTài liệu tham khảo
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