Surgery Decision Support Intervention For Early Breast Cancer Patients

ObjectiveTo explore and describe the current situation and influencing factors of early breast cancer patients’ actual decision-making participation behavior in the initial surgery.To develop a surgery decision-making support intervention program based on the cooperation between doctors and nurses for early breast cancer patients,and to explore the effectiveness of the intervention in promoting early breast cancer patients’ actual decision-making participation behavior,reducing the decision-making conflict,improving participation competence and self-care self-efficacy of patients.MethodsThis study was divided into two parts.Part one: Cross-sectional study.Convenience sampling was used to select early breast cancer patients who met the inclusion criteria in a third-class hospital in Zhengzhou from December 2019 to March 2020 for investigation and analysis of influencing factors.Data were collected by the demographic and clinical characteristics questionnaire,Patient Participation Competence Scale(PPCS),Strategies Used by People to Promote Health(SUPPH),Perceived Social Support Scale(PSSS),Actual Participation in Decision-making Scale,and then the data were analyzed by SPSS 21.0.Independent sample t-test or one-way analysis of variance were used to compare the total scores of early breast cancer patients’ actual decision-making participation behavior in the initial surgery among patients with different characteristics.Pearson correlation analysis was used to test the correlation between the total score of actual decision-making participation behavior and participation competence,self-care self-efficacy and perceived social support.Multiple linear regression analysis was used to analyze the influencing factors involved in the decision-making participation behavior in the initial surgery.The test level α=0.05.Part Two: Intervention Phase.This part is a quasi-experimental study.Based on the influencing factors obtained in the first part,78 early breast cancer patients in two courtyards of a 3A hospital in Zhengzhou were enrolled,with 39 patients in each group.The groups were divided into the intervention group and the control group by the coin flip method.Patients in the control group received routine medical admissions and preoperative health education.Patients in the intervention group received interventions of surgery decision support on the first day of admission,the second day of admission,and the day of preoperative talk.Data was collected before the intervention and 1 day before discharge,questionnaires were Decision Conflict Scale(DCS),PPCS,SUPPH and Actual Participation in Decision-making Scale.Rate,frequency,percentage,(?)±S,median and quarterback distance were used to describe the collected data,using two independent sample t test,non-parametric rank sum test,χ2 test,paired t test to analyze statistical significance.ResultsPart Ⅰ: Cross-sectional studyA total of 234 participants were recruited in this study,among which 218 valid questionnaires were collected,with an effective recovery rate of 93.2%.1.In this study,the total score of actual decision-making participation behavior for surgery ranged from 14 to 34 points,with an average score of(2.03±0.48)points which was above 1.5 points,indicating that decision-making participation behavior was poor.The three items with the highest scores were "I have been encouraged to participate in care","Alternatives have been presented" and "Reasons for decisions have been given." 2.The independent sample t-test and one-way analysis of variance showed that the scores of early breast cancer patients with different ages,living environment,educational level,work status,family per capita monthly income,and disease stage involved in the early breast cancer patients’ actual decision-making participation behavior were statistically significant(P < 0.05).3.Correlation analysis results showed that the total scores of early breast cancer patients’ actual decision-making participation behavior in the initial surgery were negatively correlated with the total scores of participation competence,self-care self-efficacy and perceived social support(r=-0.819,-0.734,-0.766,P < 0.01).4.The results of multiple linear regression analysis showed that participation competence,self-care self-efficacy,perceived social support,educational level,family per capita monthly income and work status were the main influencing factors for the actual decision-making participation behavior(P < 0.01),which accounted for 76.8%of the total variation.Part Ⅱ: Intervention StageA total of 5 early breast cancer patients were lost to follow-up during the intervention,and a total of 73 subjects were finally completed the intervention,including 37 cases in the intervention group and 36 cases in the control group.1.Before the intervention,there were no statistically significant differences in general information,total scores of decision conflict and each dimension,total scores of participation competence and each dimension,total scores of self-care self-efficacy and each dimension between the intervention and the control group(P > 0.05).2.After the intervention,there were statistically significant differences in the total score and each item score of actual decision-making participation behavior between the two groups(P < 0.05).Except for item 4,the score of "My consent to treatment has been asked" showed no statistically significant difference(P > 0.05).3.After the intervention,there were significant differences in the total score and each dimension score of decision conflict、participation competence、self-care self-efficacy between the two groups(P < 0.05).There were significant differences in the total score and each dimension score of decision conflict 、 participation competence 、self-care self-efficacy in the intervention group before and after intervention(P <0.05).4.After the intervention,there was no significant difference in the surgery types of the two groups(P > 0.05).Conclusion1.In this study,early breast cancer patients’ actual decision-making participation behavior in the initial surgery needs to be improved,which mainly manifested in the three items of "I have been encouraged to participate in care","Alternatives have been presented" and "Reasons for decisions have been given." 2.The higher level of participation competence,the higher level of self-care self-efficacy,the higher level of social support,the higher educational level,the higher family per capita monthly income,and the better decision-making participation behavior among early breast cancer patients.3.The intervention program of surgery decision support for patients with early breast cancer can reduce the level of decision-making conflict,improve the level of participation competence and self-care self-efficacy,but it has no significant influence on the final surgery types chosen by patients.