Prioritizing patient values—who/what matters most—is central to palliative care and critical to treatment decision making. Yet which factors are most important to family caregivers in these decisions remains understudied. Using data from a U.S. national survey of cancer caregivers (N = 1661), we examined differences in factors considered very important by caregivers when partnering with patients in cancer treatment decision making by cancer stage and caregiver sociodemographics. Fifteen factors were rated on a 4-point Likert-scale from ‘very unimportant’ to ‘very important.’ Descriptive statistics were used to characterize caregiver factors and tabulate proportions of importance for each. Generalized linear mixed effect modeling was used to examine the importance of factors by cancer stage, and chi-square analyses were performed to determine associations between caregiver sociodemographics and the five most commonly endorsed factors: quality of life (69%), physical well-being (68%), length of life (66%), emotional well-being (63%), and opinions/feelings of oncology team (59%). Significant associations (allp’s < 0.05) of small magnitude were found between the most endorsed factors and caregiver age, race, gender, and ethnicity, most especially ‘opinions/feelings of the oncology team’. Future work is needed to determine the best timing and approach for eliciting and effectively incorporating caregiver values and preferences into shared treatment decision making.
将患者价值观置于首位——即什么对患者最为重要——是姑息治疗的核心，也是治疗决策的关键。然而，在癌症治疗决策中，哪些因素对家庭照护者最为重要，目前仍缺乏深入研究。基于美国一项全国性癌症照护者调查数据（N = 1661），我们分析了照护者与患者共同参与癌症治疗决策时，不同癌症分期及照护者社会人口学特征下被认定为“非常重要”的影响因素差异。研究采用李克特四点量表对15项因素进行评分（从“非常不重要”到“非常重要”），通过描述性统计对照护者特征及各因素重要性比例进行量化分析。运用广义线性混合效应模型检验癌症分期对因素重要性的影响，并通过卡方检验分析照护者社会人口学特征与五大最受关注因素之间的关联性。这五大因素包括：生活质量（69%）、生理健康（68%）、生存期（66%）、心理健康（63%）以及肿瘤科团队的意见/感受（59%）。研究发现，最受关注的因素与照护者年龄、种族、性别及民族之间存在显著关联（所有p值<0.05），其中“肿瘤科团队的意见/感受”关联性尤为突出，但效应量普遍较小。未来需进一步探索最佳时机与方法，以有效获取并整合照护者的价值观与偏好，促进共同决策的实践。
肿瘤(癌症)患者之家