Tomada de Decisão Compartilhada em Oncogeriatria
preferência de controle, autonomia percebida e fatores associados
DOI:
https://doi.org/10.15448/2357-9641.2026.1.49344Palabras clave:
tomada de decisão compartilhada, oncologia, geriatria, preferência do pacienteResumen
Objetivos: Evaluar la preferencia de control y la percepción de la toma de decisiones compartida en pacientes ancianos con cáncer sometidos a tratamiento antineoplásico, así como identificar los factores asociados con estos resultados.
Métodos: Se trata de un estudio observacional, descriptivo y transversal realizado en dos hospitales terciarios de Porto Alegre (RS), que incluyó a ancianos ≥60 años con neoplasias sólidas que iniciaron tratamiento sistémico entre julio de 2023 y enero de 2025. Se recopilaron datos sociodemográficos, clínicos y funcionales, además de la aplicación de la Escala de Preferencia de Control y el Cuestionario de Toma de Decisiones Compartidas.
Resultados: Se evaluaron 181 ancianos, con una edad media de 70,7 años, predominantemente varones (51,9%), blancos (87,3%) y con neoplasias metastásicas (57,5%). El perfil de preferencia colaborativo fue el más frecuente (51,4%), seguido del pasivo (39,2%) y el activo (9,4%). Las preferencias pasivas se asociaron con origen privado, peor funcionalidad (PS-ECOG ≥2), limitaciones en las actividades de la vida diaria y ausencia de cirugía. La puntuación media del Cuestionario de Toma de Decisiones Compartidas fue de 73,8 (DE 11,7), siendo mayor en personas con mayor nivel educativo, sin comorbilidades, PS-ECOG 0-1 y con adaptación de dosis. Los adultos mayores con un perfil pasivo mostraron una menor percepción de la toma de decisiones compartida.
Conclusiones: La participación en las decisiones terapéuticas está influenciada por factores clínicos, funcionales y contextuales, lo que refuerza la necesidad de enfoques individualizados y centrados en la persona para fortalecer la autonomía y mejorar el proceso de toma de decisiones en oncogeriatría.
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1. Organização Mundial da Saúde – OMS. Ageing and health. Geneva: World Health Organization, 2024.
2. Blok EJ, Wolbink JN, van Bodegom-Vos L. Systemic treatment decisions in older patients with early invasive breast cancer: evidence and strategies. Ageing Cancer Res. 2025;2:45-58. https://doi.org/10.70401/acrt.2025.0001
3. Mohile SG, Dale W, Somerfield MR, Schonberg MA, Boyd CM, Burhenn PS, et al. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol. 2018;36(22):2326-2347. https://ascopubs.org/doi/10.1200/JCO.2018.78.8687
4. Karaoğlu A, Bahat G. Clinical management of older persons with cancer: Current status and future directions. Front Med. 2025;12:157-169. https://doi.org/10.3389/fmed.2025.1631044
5. Ruggiero C. Understanding aging, frailty, and resilience. In: Ruggiero C. The surgical patient: a geriatric approach beyond age. Springer; 2025. p. 87-104.
6. Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Education and Counseling. 2014;94(30):291-309. https://doi.org/10.1016/j.pec.2013.10.031
7. Gans EA, Pieterse AH, Klapwijk MS, van Stiphout F, van Steenbergen IJ, Portielje JEA, et al. Shared decision-making with older adults with cancer: Adaptation of a model through literature review and expert Opinion. Psychooncology. 2024;33(1):e6291. https://doi.org/10.1002/pon.6291
8. Hoffmann TC, Montori VM, Del Mar C. The connection between evidence-based medicine and shared decision making. JAMA. 2014;312(13):1295-1296. https://jamanetwork.com/journals/jama/fullarticle/1910118
9. Pereira EEB, Santos NB, Sarges ESNF. Avaliação da capacidade funcional do paciente oncogeriátrico hospitalizado. Rev Pan-Amaz Saude. 2014;5(4):37-44. http://dx.doi.org/10.5123/S2176-62232014000400005
10. Lino VTS, Pereira SRM, Camacho LAB, Ribeiro Filho ST, Buksman S. Adaptação transcultural da Escala de Independência em Atividades da Vida Diária (Escala de Katz). Cad. Saúde Pública. 2008;24(1):103-112. https://doi.org/10.1590/S0102-311X2008000100010
11. Viana RA. Validação do G8 e sua acurácia como preditor de óbito em pacientes oncológicos com idade igual ou superior a 60 anos. [Dissertação]. Recife: Instituto de Medicina Integral Professor Fernando Figueira; 2018.
12. Degner LF, Sloan JA, Venkatesh P. The Control Preferences Scale. Can J Nurs Res. 1997;29(3):21-43. https://static.igem.org/mediawiki/2019/8/88/T--SYSU-CHINA--TCPS.pdf
13. Dias A, Maia D, Cruz H, Loio M, Castro P, Gomes S. Questionário de decisão partilhada de 9 itens (Q-DP-9) [Internet]. 2016 [citado em 22 abr. 2026]. Disponível em: https://www.patient-als-partner.de/media/sdm-q-9_portuguese.pdf
14. Hamelinck VC, Bastiaannet E, Pieterse AH, van de Velde CJH, Liefers GJ, Stiggelbout AM, et al. Preferred and Perceived Participation of Younger and Older Patients in Decision Making About Treatment for Early Breast Cancer: A Prospective Study. Clin Breast Cancer. 2018;18(2):e245-e253. https://doi.org/10.1016/j.clbc.2017.11.013
15. Hahlweg P, Kriston L, Scholl I, Brähler E, Faller H, Schulz H, et al. Cancer patients' preferred and perceived level of involvement in treatment decision-making: an epidemiological study. Acta Oncol. 2020;59(8):967-974. https://doi.org/10.1080/0284186X.2020.1762926
16. Rencz F, Tamási B, Brodszky V, Ruzsa G, Gulácsi L, Péntek M. Did You Get What You Wanted? Patient Satisfaction and Congruence Between Preferred and Perceived Roles in Medical Decision Making in a Hungarian National Survey. Value Health Reg Issues. 2020:22:61-67. https://doi.org/10.1016/j.vhri.2020.07.573
17. Lawhon VM, England RE, Wallace AS, Williams CP, Williams BR, Niranjan SJ, et al. "It's important to me": A qualitative analysis on shared decision-making and patient preferences in older adults with early-stage breast cancer. Psychooncology. 2021;30(2):167-175. https://doi.org/10.1002/pon.5545
18. Moth EB, Kiely BE, Martin A, Naganathan V, Della-Fiorentina S, Honeyball F, et al. Older adults' preferred and perceived roles in decision-making about palliative chemotherapy, decision priorities and information preferences. J Geriatr Oncol. 2020;11(4):626-632. https://doi.org/10.1016/j.jgo.2019.07.026
19. Pollak C, Cotton K, Winter J, Blumen H. Health Outcomes Associated with Loneliness and Social Isolation in Older Adults Living with HIV: A Systematic Review. AIDS Behav. 2025;29(1):166-186. https://doi.org/10.1007/s10461-024-04471-3
20. Stahl ST, Arnold AM, Chen JY, Anderson S, Schulz R. Mortality after bereavement: the role of cardiovascular disease and depression. Psychosomatic Medicine. 2016;78(6):697-703. https://doi.org/10.1097/psy.0000000000000317
21. Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361-1367. https://doi.org/10.1007/s11606-012-2077-6
22. Rostoft S, van den Bos F, Pedersen R, Hamaker ME. Shared decision-making in older patients with cancer - What does the patient want? J Geriatr Oncol. 2021;12(3):339-342. https://doi.org/10.1016/j.jgo.2020.08.001
23. Richardson DR, Loh KP. Improving personalized treatment decision-making for older adults with cancer: The necessity of eliciting patient preferences. J Geriatr Oncol. 2022;13(1):1-3. https://doi.org/10.1016/j.jgo.2021.06.001
24. Lewis L, Farrington N, Patel HP, Wagland R, Hunt K. Experience of decision-making for older adults, their significant others, and health care professionals after a diagnosis of cancer: A systematic review. J Geriatr Oncol. 2025;16(8):102716. https://doi.org/10.1016/j.jgo.2025.102716
25. Moorman SM. Older adults' preferences for independent or delegated end-of-life medical decision making. J Aging Health. 2011;23(1):135-157. https://doi.org/10.1177/0898264310385114
26. van Open JD, Coats TJ, Conroy SP, Lalseta J, Phelps K, Regen E et al. What matters most in acute care: an interview study with older people living with frailty. BMC Geriatr. 2022;22(1):156. https://doi.org/10.1186/s12877-022-02798-x
27. Ariesen AMD, Neubert JH, Gaastra G, Tucha O, Koerts J. Risky Decision-Making in Adults with Alcohol Use Disorder—A Systematic and Meta-Analytic Review. J Clin Med. 2023;12(8):2943. https://doi.org/10.3390/jcm12082943
28. Kulkarni S, Weber SE, Buys C, Lambrechts T, Myers B, Drainoni ML, et al. Patient and provider perceptions of the relationship between alcohol use and TB and readiness for treatment: a qualitative study in South Africa. Res Sq. 2023;1-20. https://doi.org/10.21203/rs.3.rs-3290185/v1
29. Bernstein EY, Magane KM, Dukes KA, Palfai TP, Lee JH, Saitz R, et al. Correlates of post-hospitalization naltrexone adherence for alcohol use disorder. Drug Alcohol Depend. 2024;265:112470. https://doi.org/10.1016/j.drugalcdep.2024.112470
30. Tak HJ, Ruhnke GW, Meltzer DO. Association of Patient Preferences for Participation in Decision Making With Health-Care Experiences and Satisfaction. JAMA. 2013;173(13):1195-1203. https://doi.org/10.1001/jamanetworkopen.2020.18766
31. Epstein RM, Street Junior RL. The values and value of patient-centered care. Ann Fam Med. 2011;9(2):100-103. https://doi.org/10.1370/afm.1239
32. Nkhoma KB, Cook A, Giusti A, Farrant L, Petrus R, Petersen I, et al. A systematic review of impact of person-centred interventions for serious physical illness in terms of outcomes and costs. BMJ Open. 2022;12(7):e054386. https://doi.org/10.1136/bmjopen-2021-054386
33. Elkefi S, Asan O. The Impact of Patient-Centered Care on Cancer Patients’ QOC, Self-Efficacy, and Trust Towards Doctors: Analysis of a National Survey. J Patient Exp. 2023;10. https://doi.org/10.1177/23743735231151533
34. Brom L, Pasman HRW, Widdershoven GAM, van der Vorst MJDL, Reijneveld JC, Postma TJ, et al. Patients' preferences for participation in treatment decision-making at the end of life: qualitative interviews with advanced cancer patients. PLoS One. 2014;9(6):e100435. https://doi.org/10.1371/journal.pone.0100435
35. Geerts PAF, van der Weijden T, Moser A, Bos GMJ. The Perception of Shared Decision-Making in Hematology by Patients and Physicians Seems Satisfactory, but Important Steps are Still Ahead of Us. Hemasphere. 2020;4(4):e417. https://doi.org/10.1097/HS9.0000000000000417
36. Geessink NH, Ofstad EH, Rikkert MGMO, van Goor H, Kasper J, Schoon Y. Shared decision-making in older patients with colorectal or pancreatic cancer: Determinants of patients' and observers' perceptions. Patient Educ Couns. 2018;101(10):1767-1774. https://doi.org/10.1016/j.pec.2018.06.005
37. Zhang W, Weng Y, Zhang X, Shen H, Li X, Liu Y, et al. Shared decision making behavior in surgery among early breast cancer patients and associated factors using COM-B model: a latent profile analysis. J Nurs Manag. 2025;33(2):458-69. https://doi.org/10.1155/jonm/2347796
38. Kriston L, Scholl I, Hölzel L, Simon D, Loh A, Härter M. The 9-item Shared Decision Making Questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample. Patient Educ Couns. 2010;80(1):94-9. https://doi.org/10.1016/j.pec.2009.09.034
39. Grabbe P, Gschwendtner KM, Gaisser A, Kludt E, Wild B, Eich W, et al. Preferred and perceived participation roles of oncological patients in medical decision-making: Results of a survey among users of the German Cancer Information Service. Z Evid Fortbild Qual Gesundhwes. 2022:172:40-48. https://doi.org/10.1016/j.zefq.2022.04.026
40. Pinker I, Wetzlmair-Kephart L, Costa AM, Pilleron S. The role of healthcare professionals' attitudes in treatment decision-making for older adults with cancer: A scoping review. J Geriatr Oncol. 2025;16(3):102151. https://doi.org/10.1016/j.jgo.2024.102151
41. Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen MLG, Extermann M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol. 2014;32(24):2595-603. https://doi.org/10.1200/jco.2013.54.8347
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Derechos de autor 2026 Valéria Sgnaolin, Vanessa Sgnaolin, Alfredo Cataldo Neto
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
