老年（≥70岁）与年轻女性乳腺癌患者接受的治疗存在差异，虽然既往研究已经分析了该差异的影响因素，但是并未整合患者自评数据。
2018年7月4日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表加拿大多伦多大学、渥太华大学、森尼布鲁克健康科学中心的系统回顾，对影响老年女性决定接受或拒绝乳腺癌治疗的患者自评因素现有定性证据进行确定、评估和整合。
作者根据系统回顾和荟萃分析首选报告项目（PRISMA）规范进行系统回顾。通过MEDLINE、EMBASE、CINAHL、PsycINFO，对描述非转移性浸润性乳腺癌老年（≥70岁）女性决策过程患者自评影响因素的定性研究进行检索。根据定性研究报告标准（SRQR）对研究质量进行评定。共同的患者自评影响因素被编码、按主题进行组织，并整合入理论框架。
最后，检索出5998项相关研究，其中10项符合分析标准。SRQR总评分中位13.04（四分位距：12.84～13.81）。这些研究代表了一系列癌症治疗方法，大多数研究都集中于手术和初始内分泌治疗。
荟萃分析数据表明，决策过程最常见的患者自评因素包括治疗特征、个人目标或信念、患者特征、医师推荐意见、个人或家庭经历，这些因素可使患者接受或拒绝治疗，并且所有被纳入荟萃分析的研究并不一致。这些研究使用了不同的访谈指导，可能影响这些结果。
因此，该系统回顾强调了老年女性治疗决策过程影响因素的复杂性。认识并解决这些因素，可能改善老年女性与其医疗保健提供者之间关于治疗选择的谈话，并且促进治疗方案尽可能以患者为中心。
Breast Cancer Res Treat. 2018 Jul 4.
Patient-reported factors influencing the treatment decision-making process of older women with non-metastatic breast cancer: a systematic review of qualitative evidence.
Fernando A. Angarita, Maryam Elmi, Yimeng Zhang, Nicole J. Look Hong.
University of Toronto, Toronto, Canada; University of Ottawa, Ottawa, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada.
PURPOSE: Older women (≥70 years old) with breast cancer undergo different treatments than young women. Studies have examined factors that influence this disparity, but synthesized patient-reported data are lacking in the literature. This study aims to identify, appraise, and synthesize the existing qualitative evidence on patient-reported factors influencing older women's decision to accept or decline breast cancer treatment.
METHODS: A systematic review was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA) principles. Medline, Embase, CINAHL, and PsycINFO were searched for qualitative studies describing patient-reported factors influencing the decision-making process of older women (≥70 years old) with non-metastatic invasive breast cancer. Quality was assessed using the Standards for Reporting Qualitative Research (SRQR) criteria. Common ideas were coded, thematically organized, and synthesized within a theoretical framework.
RESULTS: Of 5998 studies identified, 10 met eligibility criteria. The median SRQR total score was 13.04 (IQR 12.84-13.81). The studies represented a range of cancer treatments; most of the studies focused on surgery and primary endocrine therapy. Our data show that the most common patient-reported factors in the decision-making process included treatment characteristics, personal goals/beliefs, patient characteristics, physician's recommendation, and personal/family experience. These factors led the patient to either accept or decline treatment, and were not consistent across all studies included. Studies used different interview guides, which may have affected these results.
CONCLUSIONS: This systematic review highlights the complexity of factors that influence an older woman's treatment decision-making process. Acknowledging and addressing these factors may improve discussions about treatment choices between older women and their health care providers, and encourage maximization of a patient-centered approach.
KEYWORDS: Breast cancer; Treatment; Clinical decision making; Aged; Older women
DOI: 10.1007/s10549-018-4865-0
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