Outcomes of Shared Decision-making for Elective Colorectal Cancer Surgery during the COVID-19 Pandemic in Taiwan: Experiences from a Single Medical Center

Background. Shared decision-making (SDM) is ＂a process in which doctors and patients work together to make decisions on treatment plans based on the current clinical evidence.＂ Amid the ongoing pandemic, patients and clinicians alike are concerned about contracting COVID-19 in hospitals, where extensive face-to-face discussions take place before surgery. Therefore, we performed a retrospective study to evaluate the benefits and outcomes of SDM during the COVID-19 pandemic. Methods. This retrospective study included patients receiving colorectal cancer treatment between February 1 and July 15, 2021. Clinical data were acquired from online databases of Taipei Medical University Hospital. Decision aids (a pamphlet and video clips) was accessible through the Internet. An online questionnaire assessing patients' degree of autonomy, economic considerations, postoperative ease of care, postoperative comfort, survival time, complete tumor resection, surgical complications, and changes in physical appearance was analyzed. Results. 21 patients were enrolled during the COVID-19 pandemic in Taiwan, with approximately 95% of whom stated that the online aids greatly enhanced their understanding of the differences among available surgical modalities. Overall, 74% (15/21) of the patients could make an immediate decision. For approximately 90% to 95% of the patients, concerns regarding survival time, complete tumor resection, surgical complications, and postoperative ease of care were essential factors in decision-making. Conclusions. Our findings demonstrate the effectiveness of online SDM aids in immediate decision-making during the COVID-19 pandemic. SDM fulfils social distancing regulations without compromising patients' understanding of the decision-making process. The involvement of family members in SDM is appropriate for indecisive patients.

關鍵字

Shared decision-making ； Colorectal cancer ； COVID-19 pandemic

並列摘要

目的：共享決策（SDM）是「醫生和患者共同合作，根據當前臨床證據對治療計劃做出決定的過程」。在Covid-19大流行中，擔心在手術前進行長時間的近距離面對面討論而感染是一個大問題。因此，我們進行了一項回顧性研究，評估Covid-19大流行期間SDM實施的益處和結果。方法：一項回顧性研究納入了在2021年2月1日至2021年7月15日期間接受治療的結直腸癌患者。從台北醫科大學醫院計算機數據庫獲得臨床數據。決策所需的信息可通過互聯網以及包括教育小冊子和視頻在內的決策輔助工具獲得。在線問卷包含與患者自主權、理解程度、經濟原因、護理便利性、美容和腫瘤完整性相關的因素。結果：在3級流行病警報期間，21名患者被納入研究。大多數受訪者（95%）表示，在線幫助極大地增強了他們對所有可用方法之間差異的理解。74%（15／21）的患者可以立即做出關於手術入路類型的手術決定，只有29%（6／21）的患者仍然猶豫不決。90%－95%的患者認為生存時間和腫瘤完全切除、手術並發症和護理的便利性是決策的重要因素。結論：我們的研究結果表明，在全球大流行期間，在線SDM有助於立即做出決策。它主要滿足了保持社交距離的需要，同時又不影響患者對決策的理解。家庭成員參與SDM適合於對最終手術決定猶豫不決的患者。

並列關鍵字

共同決策；結直腸癌； COVID-19大流行

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Outcomes of Shared Decision-making for Elective Colorectal Cancer Surgery during the COVID-19 Pandemic in Taiwan: Experiences from a Single Medical Center

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