基于医患共享决策的乳腺癌多学科诊疗模式建立:前瞻性随机对照研究

Establishment of multidisciplinary diagnosis and treatment model for breast cancer based on doctor-patient shared decision-making:a prospective randomized controlled study

目的评估基于医患共享决策的多学科诊疗模式对乳腺癌患者治疗效果、生存质量和术后并发症的影响。方法采用随机对照设计,将纳入的100例乳腺癌患者随机均分为对照组和干预组,对照组接受传统治疗模式,干预组则实施基于医患共享决策的多学科诊疗模式。比较2组患者在治疗效果、生存质量和术后并发症发生方面的差异。结果干预组患者辅助放化疗完成率为94.0%,高于对照组的80.0%,差异有统计学意义(P=0.037);对术后乳房外形满意度干预组为90.0%,高于对照组的60.0%,差异有统计学意义(P<0.001);出现Ⅲ/Ⅳ级毒副反应2组间的差异无统计学意义(P>0.05);治疗后干预组患者生存质量的各项评分结果均高于对照组,其差异有统计学意(P<0.05);干预组术后并发症发生率为6.0%,低于对照组的22.0%,其差异有统计学意义(P=0.021)。结论基于医患共享决策的多学科诊疗模式在乳腺癌患者治疗中的应用显著改善了治疗效果和生存质量,同时有效降低了术后并发症发生率。该模式为乳腺癌的治疗提供了一种更加个性化、综合性和高效的新路径。

Objective To evaluate the effects of multi-disciplinary diagnosis and treatment model based on doctor-patient shared decision making on treatment outcomes,quality of life and postoperative complications of breast cancer patients.Methods A total of 100 breast cancer patients were included in this study through a prospective randomized controlled design,and were randomly divided into control group and intervention group,with 50 patients in each group.The control group received traditional treatment mode,while the intervention group implemented a multidisciplinary treatment mode based on doctor-patient sharing decision making.The results of treatment,quality of life and postoperative complication rate were compared between the two groups.Results The completion rate of adjuvant radiotherapy and chemotherapy in the intervention group was 94.0%,which was higher than that in the control group(80.0%),and the difference was statistically significant(P=0.037).The satisfaction rate of postoperative breast appearance in the intervention group was 90.0%,which was higher than that in the control group(60.0%),with statistical significance(P<0.001).There was no significant difference in gradeⅢ/Ⅳtoxicity between the two groups(P>0.05).After treatment,the scores of patients’quality of life in the intervention group were higher than those in the control group,and the difference was statistically significant(P<0.05).The incidence of postoperative complications in the intervention group was 6.0%,which was lower than that in the control group(22.0%),and the difference was statistically(P=0.021).Conclusions The application of multidisciplinary diagnosis and treatment model based on doctor-patient sharing decision-making in the treatment of breast cancer patients has significantly improved the treatment effect and quality of life,and effectively reduced the rate of postoperative complications.This model provides a new approach to the treatment of breast cancer that is more personalized,comprehensive and efficient.