中年肺癌化疗患者参与跨专业共享决策方案的制订及实施

目的 提高中年肺癌化疗患者诊疗共享决策的参与度及效果。 方法 将76例中年肺癌化疗患者按住院时间分为对照组和试验组各38例,对照组实施常规诊疗告知与相关护理,试验组在常规护理基础上实施跨专业共享决策干预。 结果 干预后,试验组患者健康素养得分及参与医疗决策满意度得分显著高于对照组,决策困境得分显著低于对照组（均P＜0.05）。 结论 中年肺癌化疗患者参与跨专业共享决策方案的实施有利于提高患者健康素养,降低患者决策困境,提升参与决策满意度。     

ICU患者替代决策者决策疲劳现象学研究

目的 分析ICU患者替代决策者的决策疲劳体验，为医护人员实施决策辅助提供参考。方法 采用目的抽样法，对12名ICU患者替代决策者进行半结构式访谈, 采用Colaizzi分析法进行资料分析及主题提炼。结果 ICU患者替代决策者存在决策疲劳，可归纳为5个主题：决策能力有限，负性情绪加剧，决策过程中的困境，决策过程中的冲突和决策支持资源不足。结论 ICU患者替代决策者者面临决策疲劳，医护人员应针对替代决策者决策疲劳采取干预措施，以推进决策辅助支持及共享决策的实施，提高决策质量，改善患者结局。     

护理人员对护患共享决策实践认知的质性研究

目的了解护理人员对护患共享决策实践的认知,为促进高质量护患共享决策实践提供参考。方法采用质性研究中的现象学研究法,对4所三甲医院的20名护士进行半结构式深度访谈,采用Colaizzi 7步分析法对资料进行整理分析。结果共提炼出4个主题及所属的10个亚主题:对护患共享决策实践的态度(肯定认同、疑惑犹豫),实践过程的认知(实施顺畅、实施困难),实践中的障碍因素(护士自我效能不足、患者支持系统缺乏、共享决策支持系统不完善)和对实践的建议(提供护患双方情感支持、提升专业素养、完善决策管理支持系统)。结论护理人员对护患共享决策秉持积极的认知观并发挥主动引导参与的作用,在实践过程中面对一定的现实阻力和困境。各级管理者需关注并优化决策支持系统和完善实践模式,以促进护患共享决策高效实施。     

中青年终末期肾脏病患者决策困境的现象学研究

目的分析中青年终末期肾脏病患者的决策困境,旨在为医护人员实施决策辅助提供参考。方法采用现象学研究方法,对14例中青年终末期肾脏病患者进行半结构式访谈。结果中青年终末期肾脏病患者存在决策困境。可归纳为4个主题:观念困境、情绪困境、信息困境、沟通困境。结论中青年终末期肾脏病患者面临决策困境,医护人员应针对患者遭遇的困境采取干预措施,以推进共享决策的实施。     

儿科领域医疗共享决策研究现状及展望

概述共享决策理念的起源、发展,儿科患者参与共享决策的因素主要为认知能力、决策能力、社会支持、法律伦理等;总结儿科共享决策参与现状,认为儿科领域的决策参与现状不容乐观,患儿、患儿父母或法定监护人、医疗保健人员三方决策参与度均较低。提出共享决策在儿科领域有重要作用,我国儿科医务人员应开展更多的相关研究,为共享决策在我国儿科领域的推广应用提供参考。     

主动脉夹层患者术前决策现状及影响因素分析

目的 了解主动脉夹层患者术前决策现状并分析其影响因素,为决策辅助方案构建提供参考.方法 在患者知情同意的基础上,采用一般资料调查表、决策参与量表、决策冲突量表对110例主动脉夹层患者进行调查.结果 主动脉夹层患者术前决策过程中,59例(53.64％)倾向于与医生共享决策,但实际参与过程中60例(54.54％)为被动决策...     

基于共享决策的青少年与青年癌症患者生育力保存研究进展

癌症相关治疗会损害癌症幸存者的生育力。生育力保存可帮助癌症幸存者保护其生殖内分泌功能或保存生殖潜能。在青少年与青年癌症患者中开展生育力保存的共享决策,有助于患者做出最符合自己价值观和偏好的生育力保存决策,减少决策冲突和决策后悔。本文对青少年与青年癌症患者生育力保存的共享决策的相关概念、发展现状、决策模式、挑战及其对策进行综述,为促进青少年和青年患者生育力保存共享决策和提升生活质量提供参考。     

癌症患者参与能力对其感知医患共同决策水平的影响

目的 探讨癌症患者参与能力对其感知医患共同决策水平的作用，以期为促进患者参与治疗决策提供参考。方法 选取广州市4所三甲医院住院的458例癌症患者作为研究对象，采用患者参与能力量表、中文版医患共同决策量表患者版评估患者的参与能力和感知医患共同决策水平。采用分层回归方法，探讨在控制患者的社会人口学特征和疾病资料时患者的参与能力对其感知医患共同决策水平的影响。结果 患者医患共同决策水平总分为65.67(44.44,79.00)分,参与能力量表总得分为(96.80±21.02)分。控制患者的社会人口学特征和疾病资料后，患者参与能力量表的3个维度（信息获取能力、沟通交流能力、自主决策能力）能解释患者感知的医患共同决策水平37.5%的变异(均P<0.05)。结论 医护人员应重视评估患者的参与能力，并采取措施来提升患者的信息获取能力、沟通交流能力、自主决策能力，以推动医患共同决策在临床上实施。     

决策辅助工具用于乳腺癌患者的研究进展

乳腺癌是全球女性高发的恶性肿瘤之一,随着医学模式的转变和循证观念的提出,乳腺癌患者参与治疗护理决策的意愿逐渐增强,但患者实际参与决策的程度低于参与意愿。决策辅助工具可帮助患者了解疾病相关信息,促进患者结合自身偏好和价值观参与决策的制定,降低患者的决策冲突,提高患者满意度。现就患者决策辅助工具的概念,决策辅助工具在国内外乳腺癌患者中的应用现状及影响因素进行综述分析,旨在为促进临床应用决策辅助工具,有效落实共享决策提供参考依据。     

“互联网+”患者决策辅助工具应用的研究进展

对"互联网+"患者决策辅助的概述、用途、形式及特点进行综述,"互联网+"患者决策辅助工具的主要形式包括网站、移动应用程序、集合患者电子健康记录和虚拟决策实验室,医护人员使用"互联网+"患者决策辅助工具可促进患者自我管理、推动疾病筛查、预防工作和协助共享决策过程的医患沟通等,并对其应用的影响因素进行综述,旨在为我国医护人员使用"互联网+"患者决策辅助工具提供参考依据。     

成年癌症患者生育力保存决策体验质性研究的Meta整合

目的 系统整合癌症患者生育力保存决策体验的质性研究,为辅助癌症患者做决策及改进现有决策支持体系提供循证依据。方法 计算机检索PubMed、EMbase、The Cochrane Library、CINAHL、Web of Science、PsycINFO、Scopus、中国知网、万方数据库、维普数据库关于癌症患者生育力保存决策的质性研究,检索时限为建库至2022年8月。采用JBI循证卫生保健中心质性研究质量评价标准对文献进行质量评价,采用Meta整合中汇集性整合方法对结果进行整合。结果 共纳入18篇文献,提炼出67个研究结果,将相似结果归纳成7个新的类别,并综合成3个整合结果：对生育力保存风险-收益的艰难权衡,紧迫决策下复杂的心理变化过程,决策过程的干扰。结论 医护人员及相关卫生机构应重视癌症患者生育力保存决策的心理体验和信息需求,优化决策程序、开发决策辅助方案,促进患者尽快完成决策。     

A model of knowledge acquisition in early stage breast cancer patients

To meaningfully participate in the decision-making regarding a newly diagnosed breast cancer, a patient must acquire new knowledge. We describe a model of knowledge acquisition that can provide a framework for exploring the process and types of knowledge that breast cancer patients gain following their diagnosis. The four types of knowledge presented in this model-authoritative, technical, embodied, and traditional-are described and potential sources discussed. An understanding of knowledge acquisition in early stage breast cancer patients can provide healthcare practitioners with an important framework for optimizing decision-making in this population.     

Breast cancer risk assessment and prevention: a framework for shared decision-making consultations

Options for breast cancer prevention, used in combination with screening and surveillance, include lifestyle modifications, chemoprevention with tamoxifen, and prophylactic surgery. Preventive health decisions are often preference driven: patients typically must choose whether to initiate effective treatments that hold the possibility of side effects that can negatively impact quality of life. This situation demands that patients be well informed and have a full understanding of the risks associated with each option. Investigators have developed a comprehensive decision-making framework designed to support breast cancer prevention consultations within a shared decision-making setting. The framework integrates predictive information from current risk models within the context of a woman's general health to appropriately frame breast cancer risk management consultations and outlines the application of available treatments and emerging biomarker information to individual patient decisions. Using an evidence-based approach, specialized risk-benefit projections can be provided in the clinical setting. A more comprehensive individualized risk profile allows for tailored medical management plans and can better prepare patients to make informed decisions. The framework is intended to encourage a shared decision-making approach to prevention consultations, a method for researchers to increase accrual to trials, and to more quickly incorporate new findings into the routine of practice.     

Patients' preferences for communicating a prostate cancer diagnosis and participating in medical decision-making

OBJECTIVES: To assess patients' preferences about how physicians' deliver news of a prostate cancer diagnosis, and patients' preferred participation in medical decision-making, with a secondary objective being to validate the Measure of Patients' Preferences (MPP) scale with these patients. PATIENTS AND METHODS: Eighty-seven men (mean age 62.4 years) referred to an ultrasound/radiology department for their first transrectal ultrasonography (TRUS)-guided biopsy completed the MPP and Control Preferences measures. Patients were asked to identify how they would like to be told about a potential prostate cancer diagnosis by their physician, and what role they would like in making treatment-related decisions with their physicians. RESULTS: Most patients wanted either an active (43%) or collaborative (47%) role in medical decision-making if the TRUS showed prostate cancer. Men rated content items (what and how much information is provided by their physician) as more important than supportive (emotional support during interaction) or facilitative (setting and context variables) items. Men who preferred a collaborative role in the patient-physician interaction wanted significantly (P = 0.04) more content (detailed information on available treatments and the effect of these treatments on their quality of life) than men who had a preference for either an active or passive role in medical decision-making. Demographic characteristics were not indicative of either preferred role in decision-making or communication preferences. The MPP was shown to be reliable. CONCLUSIONS: Men have expectations about how physicians disclose a diagnosis of prostate cancer and how they wish to participate in making treatment decisions. These results underline the importance of identifying patient preferences before embarking on treatment discussions, as the way 'bad news' is disclosed has previously been identified as a predictor of the outcome of the patient-physician interview.     

Decisional regret and quality of life after participating in medical decision-making for early-stage prostate cancer

OBJECTIVE: To determine the effect of men's reported levels of involvement in medical decision-making and quality of life (QoL) on their levels of decisional regret after definitive treatment. PATIENTS AND METHODS: Men referred to a hospital-based resource centre completed QoL and decisional-regret measures after definitive treatment for localized prostate cancer. Data from these questionnaires were linked with a previous study conducted to determine if providing individualized information to men newly diagnosed with prostate cancer would lower their levels of psychological distress and enable them to become more active participants in treatment decision-making. The preferred role in medical decision-making and QoL had previously been measured at the time of diagnosis and the assumed role at 4 months after the definitive treatment decision. This postal survey was conducted approximately 18 months after diagnosis. RESULTS: Of 74 men, 67 (91%) responded; the mean (sd) time since definitive treatment was 10.3 (4.7) months and the mean age of the men 62.5 (6.9) years. Radical prostatectomy was the most frequent treatment (72%). Most (94%) patients participated in medical decision-making either actively or collaboratively and did not regret their treatment choice. The type of definitive treatment received had no effect on decisional regret; patients' QoL scores were similar to the levels before treatment. Levels of sexual function were significantly lower after definitive treatment, but urinary incontinence was not significantly affected. Men who had neoadjuvant hormone therapy reported having significantly more treatment-related symptoms. CONCLUSIONS: There is no evidence that providing information to facilitate participation in medical decision-making causes decisional regret or psychological distress within the first year after definitive treatment. A longitudinal follow-up of these patients is required to adequately assess the long-term effects of treatment on QoL and decisional regret.     

Quality of life and symptom assessment in randomized clinical trials of bladder cancer: A systematic review

ObjectivesPatient-reported outcomes (PRO) help patients, caretakers, clinicians, and policy makers make informed decisions regarding treatment effectiveness. Our objective was to assess the quality of PRO reporting and methodological strengths and weaknesses in randomized controlled trials (RCT) in bladder cancer.MethodsA systematic literature search of bladder cancer RCT published between January 2004 and March 2014 was performed. Relevant studies were evaluated using a predetermined extraction form that included trial demographics, clinical and PRO characteristics, and standards of PRO reporting based on recommendations of the International Society for Quality of Life Research.ResultsIn total, 9 RCTs enrolling 1,237 patients were evaluated. All studies were in patients with nonmetastatic disease. In 5 RCTs, a PRO was the primary end point. Most RCTs did not report the mode of administration of the PRO instrument or the methods of collecting data. No RCT addressed the statistical approaches for missing data.ConclusionsWe found that few RCTs in bladder cancer report PRO as an outcome. Efforts to expand PRO reporting to more RCTs and improve the quality of PRO reporting according to recognized standards are necessary for facilitating clinical decision making.     

Pilot trial of a computerized decision aid for breast cancer prevention

This study sought to evaluate a shared decision-making aid for breast cancer prevention care designed to help women make appropriate prevention decisions by presenting information about risk in context. The decision aid was implemented in a high-risk breast cancer prevention program and pilot-tested in a randomized clinical trial comparing standard consultations to use of the decision aid. Physicians completed training with the decision aid prior to enrollment. Thirty participants enrolled (15 per group) and completed measures of clinical feasibility and effectiveness prior to, immediately after, and at 9 months after their consultations. The decision aid was feasible to use during the consultations as measured by consultation duration, user satisfaction, patient knowledge, and decisional conflict. The mean consultation duration was not significantly different between groups (24 minutes for intervention group versus 21 minutes for control group, p = 0.42). The majority found the decision aid acceptable and useful and would recommend it to others. Both groups showed an improvement in breast cancer prevention knowledge postvisit, which was significant in the intervention group (p = 0.01) but not the control group (p = 0.13). However, the knowledge scores returned to baseline at follow-up in both groups. Decision preference for patients who chose chemoprevention post consultations remained constant at follow-up for the intervention group, but not for the control group. The decision framework provides access to key information during consultations and facilitates the integration of emerging biomarkers in this setting. Initial results suggest that the decision aid is feasible for use in the consultation room. The tendency for the decision choices and knowledge scores to return to baseline at follow-up suggests the need for initial and ongoing prevention decision support.     

A prospective analysis of implementation of multi-disciplinary team decisions in breast cancer

Multi-disciplinary teams (MDTs) management of patients with cancer is mandatory in the United Kingdom, and auditing team decision-making by examining rates of decision implementation and reasons for nonimplementation may inform this practice. Consecutive breast cancer MDT decisions, subsequent decision implementation, and reasons for nonimplementation were prospectively recorded. Factors associated with nonimplementation of the MDT decision were analyzed with logistic regression. Of 289 consecutive MDT decisions involving 210 women, 20 (6.9%, 95% CIs 4.3%-10.5%) were not implemented. Most changed MDT decisions did so because of patient preferences (n = 13, 65%), with the discovery of new clinical information (n = 3) and individual doctor's views (n = 4) also leading to decision nonimplementation. MDT decisions were significantly less likely to be adhered to in patients with confirmed malignant disease compared to those with benign or 'unknown' disease categories (p < 0.001) and MDT decisions in older patients were significantly more likely not to be implemented than in younger patients (p = 0.002). Auditing nonimplementation of MDT recommendations and examining reasons for changed decisions is a useful process to monitor team performance and to identify factors that need more attention during the MDT meeting to ensure that the process makes optimal patient centered decisions.     

It’s all about the perspective: Removing bias when co-managing patients with high-grade T1 bladder cancer and localized prostate cancer—A competing risks analysis

The risk connotation of terminology in influencing decision-making should not be underestimated. For example, “superficial” T1HG bladder cancer has the same poor cancer-specific survival as that conferred by the “highest risk” prostate cancer (Gleason 10, T3b). Co-management of concomitant prostate cancer and non-muscle invasive bladder cancer requires a careful competing risk analysis by both the physician and patient. Herein, we detail how patients and physicians should be careful not to underestimate the risk attributed to “non-muscle invasive” bladder cancer.     

Markers for recurrence of superficial bladder cancer: what is valid?

The management of superficial bladder cancer is characterized by early recognition of recurrences and the prevention of progression. Several clinical markers are used to divide patients into risk groups determining treatment and follow-up schemes. Although only a small fraction of patients will progress to invasive disease, survival of these patients is largely dictated by their bladder cancer. Whether early aggressive treatment of 'high-risk' superficial bladder cancer improves survival is not the issue of this article. Here we discuss the markers available for predicting tumour recurrence and progression. Clinical markers remain the most practical in decision-making and can identify high-risk patients. Molecular markers may be useful, but as yet insufficient evidence exists on their efficacy for daily use.