Application Of Shared Decision Making Program In Decision Conflict Of Parents Of Children With Acute Leukemia

Objective:To investigate the current state of decision conflict among parents of children with acute leukemia and analyze its related influencing factors for the subsequent development of a shared decision making program.To establish a shared decision making program for acute leukemia based on the Ottawa Decision Support Framework and to explore the effects of the program on decision conflict,disease uncertainty,caregiver burden,decision readiness,decision satisfaction and discharge readiness of parents of children with acute leukemia.Methods:1.From September 2021 to April 2022,150 parents of children with acute leukemia admitted to the Hematology Department of a tertiary hospital in Shanxi Province were selected as study subjects,and the general information questionnaire,decision conflict scale and psychological resilience scale were used to analyze the main factors influencing decision conflict among parents of children with acute leukaemia.2.By systematically searching relevant literature at home and abroad,we constructed a shared decision making program for acute leukemia based on the Ottawa Decision Support Framework,invited eight experts to discuss,modify and improve the initially constructed shared decision aid program,and finally formed the final draft of the shared decision aid program.parents of 86 children with acute leukemia admitted to hematology department of a tertiary hospital in Shanxi Province from May 2022 to October 2022 were selected as study subjects.Among them,the parents of children with acute leukemia admitted from May 2022 to July 2022 were taken as the control group and given routine care,and the parents of children with acute leukemia admitted from August 2022 to October 2022 were taken as the intervention group,and the shared decision making program intervention was implemented on the basis of routine care.The differences in general data,decision conflict,disease uncertainty,caregiver burden,decision readiness,decision satisfaction and readiness for discharge between the two groups of parents of children with acute leukemia were compared before and after the intervention of discharge to evaluate the effects of the intervention.Results:1.The total score of decisional conflict of parents of children with acute leukemia was(38.67±6.37),which was at a high level;the total score of psychological flexibility of parents of children with acute leukemia was(58.74±13.56),which was at a medium level,and the decisional conflict of parents of children with acute leukemia was negatively correlated with psychological flexibility(r=-0.833,P<0.05),and the age,education level and psychological flexibility of children with acute leukemia were the main influencing factors of decision conflict among parents of children with acute leukemia(P<0.05).2.A total of 86 children and parents with acute leukemia were included in this study.There was no statistical significance in the general information questionnaire of children and their parents between the two groups(P>0.05).Before intervention,there was no statistically significant difference in the score of decision conflict between parents of children in the two groups(P>0.05),but after intervention,the score of decision conflict between parents of children in the intervention group was lower than that in the control group(P<0.05).Before intervention,there were no statistically significant differences in the scores of disease uncertainty and caring burden of parents in the two groups(P>0.05).After intervention,the scores of disease uncertainty and caring burden of parents in the intervention group were significantly lower than those in the control group(P<0.05).Repeated measurement analysis of variance showed that,The time and interaction effects of disease uncertainty and caregiving burden ccore before and after intervention were significant(P<0.05).After intervention,there were significant differences in the scores of decision preparation,participation satisfaction and discharge readiness of parents in the two groups(P<0.05).Conclusion:1.Parents of children with acute leukemia have a high level of decision conflict,indicating that parents have an uncertain and hesitant state of decision content in the process of diagnosis,treatment and nursing of children ’s diseases.Age,education level and psychological resilience are the main influencing factors of decision conflict of parents of children with acute leukemia.2.The shared decision making program intervention constructed in this study was effective in reducing the level of decision conflict,disease uncertainty and caregiver burden of parents of children with acute leukemia,and improve parents’ decision preparation,discharge readiness and decision satisfaction.