| Research Objectives:To compile a questionnaire on the knowledge,attitude and dilemma of shared decision-making of medical staff in pediatric hematological oncology from the perspective of doctors and nurses.In addition,we used self-designed questionnaire to investigate the cognitive level,attitude,current decision-making dilemma and difficulties in promoting Shared decision-making model in pediatric hematological oncology in China,and to analyze the relevant influencing factors.To provide a reference basis for the development of decision support tools for decision agents of children with hematological tumors based on China’s national conditions,in order to reduce the level of decision conflict among decision-makers,promote doctor-patient co-decision,so as to obtain satisfactory medical outcomes and improve doctor-patient relationship.Research methods:Part Ⅰ: through literature research,expert consultation and questionnaire survey,the questionnaire was developed to investigate the shared decision-making knowledge,attitude and dilemma of medical staff in pediatric hematology department.1.Literature Review: Select keywords retrieval tactics and develop,the multiple databases at home and abroad were reviewed and retrieval system,looking for domestic and foreign literature review related to share decision-making,system evaluation,Thurber papers,journal articles,into the qualified documents,formation of children’s blood tumor specialized subject hospital staff Shared decision-making knowledge,attitude and difficulties questionnaire of initial entry pool.2.The expert consultation method: By empirical method to establish expert selection criteria,selection in the field of children’s blood tumor associated with rich theoretical knowledge and the higher the level of clinical experts in the field of medical treatment and nursing,the first draft of questionnaire compiled into expert questionnaire,through E-mail and print the questionnaire distributed expert questionnaire,and on the basis of expert opinion to revise the first draft of the questionnaire.3.Survey method(pre-survey): A preliminary survey was conducted among 26 doctors and 39 nurses from Sun Yat-sen Memorial Hospital of Sun Yat-sen University in Guangzhou,and the final questionnaire was determined after items were modified and screened.Part Ⅱ: A survey on decision-making knowledge,attitudes and dilemmas among medical staff in pediatric hematology department of 8 hospitals from 4 provinces in China.For the cross-sectional survey,this study selected 4 guangdong,guangxi,hunan and sichuan provinces 8 hospitals,308 children of onset of medical personnel as the research object,adopt the method of purposive sampling,children with homemade haematology department staff Shared decision-making knowledge,attitude and difficulties questionnaire used "questionnaire star" network platform and print the questionnaire issued to carry out the questionnaire survey,Finally,308 valid questionnaires were included.We used SPSS25.0 software for analysis,and mannWhitney U test,Kruskal-Wallis H test and Spearman Spearman correlation test were used for statistical analysis.Results:1.Form three dimensions,the doctor version of 56 items,nurse version 63 entries of the children’s blood tumor specialized subject hospital staff Shared decision-making knowledge,attitude and difficulties questionnaire ": knowledge dimension 20 items,the attitude dimension share 14 items,medical care personnel to separate survey 7items,trouble dimension 19 items and three open questions.The results of the first round of expert consultation showed that the I-CVI of 14 of the 60 items except the open questions was lower than 0.78.The result of the second round of expert consultation was that the I-CVI of 60 items except the open questions reached 1.Questionnaire knowledge dimension KR20=0.727;Attitude dimension(doctor version)Cronbach’s α=0.744;Attitude dimension(nurse version)Cronbach’sα=0.888;Cronbach’s α=0.864.The dimensions of the questionnaire are basically in line with the dimensions set by the theoretical basis of this study,and can better reflect the shared decision-making knowledge,attitude and dilemma of medical staff in pediatric hematological oncology.2.A total of 308 pediatric hematological oncologists were included in this study,including 143 physicians(46.4%)and 165 nurses(53.6%).The findings are as follows:(1)Knowledge: the median score of medical staff knowledge part was 12.00(10.00,13.0),the proportion of knowledge level was "good" was 12.0%(n = 37),and that of "poor" was 2.8%(n = 9);(2)Attitude: the median score of medical staff was 3.00(2.00,3.00).Among them,the results of the survey only on nurses’ attitudes show that nurses generally hold a positive attitude towards joint decision-making,31.6%(N = 52)of nurses believe that clinical nurses now occasionally or not participate in doctor-patient decisionmaking process,and at the same time,85.5%(N=141)of the surveyed nurses thought that it was necessary to implement the joint decision model in the clinical practice of children hematological tumors in China;(3)Dilemma: The results showed that most of the surveyed medical staff believed that the patient decision-making agent lacked the medical knowledge necessary for medical decision-making(n= 193,62.7%),the choice of multiple treatment options(n= 190,61.7%)and the difference in treatment preference(n=177,57.5%)is the key factor leading to the difficulty of joint decision making in pediatric hematological oncology;(4)Correlation analysis results: occupation(medical care),understanding of codecision and education level before filling in the questionnaire had significant influence on the score of co-decision knowledge in clinical care of hematological oncology in children(P<0.05);Whether children were born or not and the level of hospital(grade iii special hospital,grade III hospital and grade II hospital)had significant influence on the attitude of joint decision-making of children’s hematology and oncology department(P<0.05).Spearman correlation test results showed that more than half of attitude items were negatively and significantly correlated with knowledge level,indicating that medical staff with high knowledge score had more positive attitude towards joint decision making.3.The results of the open questions are as follows: The respondents believe that the most important dilemmas in the clinical medical decision-making of children’s hematological tumors include (1) patients’ lack of medical decision-making knowledge;(2) doctor-patient communication problems;(3)Time limit (4)Lack of support.The respondents suggested to carry out doctor-patient joint decisionmaking in pediatric hematological oncology in China:(1)to strengthen the education of patients;(2)strengthen the training of medical personnel;(3) develop decision tools;(4)Normative co-decision team;(5)issue supporting policies.Respondents believe that if the doctor-patient co-decision model is implemented in the clinical practice of pediatric hematologic tumors,the main difficulties faced by the medical side are as follows:(1)heavy workload and insufficient time;(2)lack of knowledge;(3)doctor-patient communication barrier;(4)Insufficient support.Conclusion:1.The questionnaire on shared decision-making knowledge,attitude and dilemma of medical staff in pediatric hematological oncology developed in this study has good reliability and validity,and can better evaluate the shared decision-making knowledge,attitude and dilemma of medical staff in pediatric hematological oncology.2.The knowledge level of joint decision making of medical staff in pediatric hematological oncology is poor but their attitude is more positive.The results of univariate analysis showed that there was statistical significance in knowledge score of understanding of joint decision and education level before filling the questionnaire(P<0.05).Whether they had children or not and hospital level had statistical significance in attitude score(P<0.05).Key words such as time limitation,workload and lack of knowledge are frequently mentioned in the answers of medical staff to the difficulties of practicing doctor-patient co-decision mode.It is suggested to develop decision-making AIDS based on China’s national conditions,give full play to the role of nursing staff in the joint decision-making team,promote doctor-patient communication on information sharing,and improve supporting measures to promote the clinical promotion of the joint decision-making model in pediatric hematological oncology. |
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