| Objective The purpose of this study was to make a questionnaire survey on thyroid cancer patients through the patient decision-making dilemma scale and decision-making readiness scale,so as to clarify the status quo and influencing factors of thyroid cancer patients'participation in treatment decision making.Qualitative interviews were given to thyroid cancer patients,families and doctors who made the diagnosis and gave treatment to explore the attitude and influence factors toward thyroid cancer patients' participation in treatment decision making of patients and their families as well as doctors,and to provide theoretical basis for thyroid patients' participation in treatment options suitable for ChinaMethods 1.486 patients with thyroid cancer were selected from April to August 2019 in a third-class hospital in Hangzhou by cross-sectional survey.Questionnaire content includes patients' general information,behavior Scale(Karnofsky Performance Status,KPS),decision-making tendency Scale(Control the Preference Scale,CPS),Ma Lili localization treatment options for patients questionnaire,using SPSS 23.0 for statistical software,Statistical methods included statistical description,Kappa consistency test,independent sample t test,chi-square test and Logistic regression analysis to obtain the status quo and influencing factors of thyroid cancer patients' participation in decision-making on treatment methods.2.Using the phenomenological research methods,qualitative research purpose sampling method,12 thyroid cancer patients and 8 patients' relatives were interviewed from April to August of 2019 in a third-class hospital in Hangzhou.Patients attitude and influence factors of thyroid cancer patients' participation in decision-making on treatment methods were retrieved by encoding,refining the theme of interview results..3.Using the phenomenological research methods,7 doctors were interviewed using qualitative research purpose sampling method in a third-class hospital in Hangzhou.Doctors' attitude and influence factors of thyroid cancer patients' participation in decision-making on treatment methods were retrieved by encoding,refining the theme of interview results..Results 1.The following results were obtained through a questionnaire survey of 486 patients with thyroid cancer:(1)According to the survey of decision tendency scale,210 patients(43.21%)had cooperative attitude towards treatment decision participation.The actual degree of treatment decision-making participation in 363 patients(74.69%)was passive.(2)A questionnaire survey on the participation of cancer patients in treatment decision-making showed that 291 patients(59.9%)and 195 patients(40.1%)of 486 thyroid cancer patients participated in the decision-making of treatment methods and had a positive attitude,respectively.However,only 120 patients with high degree of actual participation,accounting for 24.69%,and 366 patients with low degree of participation,accounting for 75.31%.(3)Kappa consistency inspection on the degree between actual participation and attitude on treatment options for patients showed that Kappa value was 0.338,all the 12 items of consistency has statistical significance(P<0.01),except for entry 8"I chose from each treatment option",the other 11 items of Kappa values are less than 0.4,shows that except for item 8,the actual participation of the other 11 items and the degree of consistency of attitude are not ideal,and the highest is 0.356,the entry for "I decided my treatment together with doctor".The lowest score in the remaining 10 entries was 0.195 for "I participated in the discussion of treatment options."(4)The possible factors influencing the attitude of thyroid cancer patients participation in the treatment decision include education level,number of children,living environment,religious belief,main sources of medical expenses,part of the sources of self-pay,whether to enter the hospital for the first time,and the experience of previous medical services.Through multi-factor analysis,it can be learned that patients with high education level,children involved,living in central cities,with religious belief,payment method is the new rural medical cooperative insurance,and patients admitted to medical institutions for the first time have a more positive attitude to participate in the treatment decision-making.Age,education level,marital status,number of children,living environment,main sources of medical expenses,and previous medical service experience are the possible factors influencing the actual participation of thyroid cancer patients in treatment decision-making.Through multi-factor analysis showedthat patients with high education level and no spouse are more involved in treatment decision-making.2.Through semi-structured interviews with 12 patients with thyroid cancer,four themes were extracted,including:active attitude to participate in treatment decision-making;Benefits of participating in treatment decisions;Factors that influence decision making;Measures to promote participation in treatment decision-making.3.Through semi-structured interviews with family members of 8 thyroid cancer patients,six themes were extracted,namely:participating in treatment decision-making;Family members' attitudes towards participating in treatment decisions;Factors influencing treatment decision making;Family members have psychological concerns;Promoting patients' participation in decision-making measures;The promoting role of family members.4.Through semi-structured interviews with 7 doctors engaged in the diagnosis and treatment of thyroid cancer,five themes were extracted,namely:the form of treatment decision-making participation;advantages of patient participation in treatment decisions;support patients to participate in treatment decisions;factors that prevent patients from participating in treatment decisions;promote the participation of patients in treatment decision-making measures.Conclusion 1.The survey shows that thyroid cancer patients have a positive attitude towards treatment decision-making,but the actual degree of participation is not ideal,and there is still a long way to go in promoting thyroid cancer patients to participate in treatment decision-making.To promote the participation of thyroid cancer patients,we can gradually explore a reasonable mode for patients to participate in treatment decisions through pilot operation,and then gradually promote it to the affected population.Medical care should cooperate with each other and give full play to multidisciplinary collaboration.Young and middle-aged patients who are willing to participate,highly satisfied with medical services,highly educated and extroverted should be selected to participate in the treatment decision.2.Patients' family members play a great role in patients' participation in treatment decision-making,such as providing information support,psychological support,economic support,decision support and care,etc.The role of patients' participation in treatment decision-making cannot be ignored.But at the same time,the patients' families also have a lot psychological pressure.As medical staffs,they should pay attention to the psychological evaluation of the patients' families with thyroid cancer,and give appropriate psychological intervention to relieve the families' bad emotions,which is conducive to the health of patients and patients' participation in treatment decisions.3.Compared with other cancer,thyroid cancer's prognosis is good,the recurrence rate is low,patients also had good recovery of body function,but when faced with "cancer",patients' psychological pressure is still large,negative emotions includetension,anxiety,fear,etc.Medical staff should give timely psychological assessment forpatients with thyroid cancer,let themhave correct knowledge of the characteristics of the disease.When it is necessary,give professional psychological counseling,effectively alleviate the psychological pressure of patients,so as to develop the confidence to participate in making treatment decisions. |
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