Une intervention en ligne de soutien à la décision pour faciliter la communication patient-médecin en lien avec le traitement du cancer de la prostate

B. Joyce Davison, Michael Szafron, Carl Gutwin, Kishore Visvanathan

Abstract


Objectif : Mesurer les préférences et les valeurs des hommes nouvellement diagnostiqués d’un cancer de la prostate (CP) au moyen d’une technologie en ligne de soutien à la décision—l’intervention de soutien à la prise de décision en lien avec le cancer de la prostate (ISPD-CP).

Méthodologie : Les comportements de recherche d’information sur la santé, les facteurs ayant une influence sur la décision thérapeutique, le contrôle décisionnel et la préférence thérapeutique ont été enregistrés par le programme d’ISPD‑CP avant la consultation thérapeutique. Chaque patient a reçu une fiche sommaire des préférences (FSP) à utiliser lors des discussions thérapeutiques. Nous avons mesuré les degrés de contrôle décisionnel et de conflit décisionnel avant et après la prise de décision thérapeutique (PDT), ainsi que la satisfaction des patients après la PDT.

Résultats : Quarante-neuf hommes ont suivi le programme d’ISPD-CP avant leur discussion thérapeutique. Parmi eux, 61 % ont montré leur FSP à leur(s) médecin(s) lors des discussions thérapeutiques. La plupart des patients (63 %) voulaient avoir accès à des renseignements approfondis ou détaillés. Les quatre facteurs qui influaient le plus sur les décisions thérapeutiques des patients étaient les suivants : l’impact du traitement sur la survie, sur la fonction urinaire et sur la fonction intestinale, et la recommandation du médecin quant au traitement le plus indiqué. Les patients ont signalé un degré de satisfaction élevé par rapport à leur décision thérapeutique et par rapport à leur participation au processus décisionnel. Les niveaux de conflit décisionnel étaient considérablement plus faibles (p < 0,001) après la PDT, et les hommes ont signalé avoir joué un rôle considérablement plus actif dans le processus décisionnel que ce qu’ils avaient originalement souhaité (p = 0,038).

Conclusions : Les résultats semblent indiquer que l’ISPD-CP peut être un outil utile pour aider les patients à cerner et communiquer leurs valeurs et préférences aux médecins dans le cadre des discussions thérapeutiques.

 Mots clés : cancer de la prostate, communication patient-médecin, intervention d’aide à la décision


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