| ObjectiveIn this study,qualitative and quantitative studies were combined to analyze the status quo of breast cancer chemotherapy patients’ participation in treatment decision-making,and to explore the factors affecting their participation in treatment decision-making,so as to provide evidence support and theoretical reference for the modern medical model of patients’ participation in treatment decision-making.Methods1 In the first part,a qualitative research method was used to conduct semi-structured interviews on 11 patients hospitalized in the Chemotherapy Department of a Grade Ⅲ A hospital in Shandong Province from August to December 2019.All interviews were conducted on the day of admission.Colaizzi 7-step method was used to analyze the contents of the interview,and the relevant factors affecting the participation of breast cancer chemotherapy patients in treatment decision-making were preliminarily obtained.2.In the second part,convenience sampling method was used to select 320 breast cancer patients from oncology departments of three Grade A hospitals in Shandong province from December 2019 to August 2020 as the research object.A questionnaire survey was conducted on the day of admission,survey tools included Herth Hope Scale(HHI),Questionnaire of Cancer Patient Involvement in Ttreatment Decision Making and Quality of Life Scale for Breast Cancer Patients(FACT-B).All data were double-checked and entered,and SPSS 17.0 was applied for analysis.The main statistical analysis methods included descriptive analysis,analysis of variance,Pearson correlation analysis and multiple stepwise regression.ResultsA total of 342 questionnaires were sent out and 320 were effectively received with an effective recovery rate of 93.56%.The results are as follows:1.Through a semi-structured interview with 11 breast cancer patients undergoing chemotherapy,four themes and nine subthemes were extracted,which were cognitive factors(cognitive diversity,the need for internal hope,the need for quality of life)of patients;Decision-making process factors(clarification of personal ideas,information transmission);Doctor-patient communication factors(doctor-patient relationship,decision-making support);Clinical practical factors(task,time).2.Among the patients,276(86.2%)were aged between 40 and 60 years old.195 patients with junior college degree or below(60.9%);257(80.3%)with a monthly income below 7,000 yuan;304 persons(95%)were married and 16 persons(5%)were widowed;181(56.6%)had only one child;198 persons(61.9%)had medical insurance;235 patients(73.4%)had a disease course of more than 6 months.286 patients(89.4%)were in Ⅱ stage;among the pathological types,286 patients(89.4%)had invasive carcinoma,233 patients(72.8%)received 6 or more chemotherapy cycles;230 patients(71.9%)were hospitalized for more than 6 times,and 279 patients(87.2%)were in Ⅱ grade.3.59.1%of the patients with breast cancer chemotherapy had a very active attitude in treatment decision-making,while only 20.3%of the patients had a very high degree of actual participation in treatment decision-making.The actual degree of participation of breast cancer chemotherapy patients in treatment decision-making is lower than the attitude of participation.4.One-way analysis of variance showed that the 10 variables including age,educational level,monthly income,religious belief,marital status,number of children,medical insurance,course of disease,hospitalization times and tumor histological grade had statistically significant differences in the scores of patients’ attitude toward treatment decision-making participation(P<0.05).Seven variables,including age,educational level,monthly income,number of children,medical insurance,disease stage and tumor histological grade,had statistical significance for the scores of the actual degree of participation in treatment decision-making(P<0.05).5.Pearson correlation analysis results showed that the attitude and actual degree of the treatment decision-making participation of breast cancer chemotherapy patients were negatively correlated with the dimensions of hope level and the total score(r ranged from 0.646 to 0.455,P<0.01).In this study,the higher the score of cancer patients in the questionnaire of treatment decision-making,the more negative their attitude is.Therefore,the higher the level of hope,the more positive their attitude is to participate in decision-making,and the higher the actual degree of participation is.The scores of attitude and actual degree of participation in treatment decision-making of breast cancer chemotherapy patients were negatively correlated with the scores and total scores of various dimensions of quality of life(r ranged from-0.560 to-0.380,P<0.01).Similarly,the higher the quality of life of patients,the more active their attitude and actual degree of participation in treatment decision-making were.6.Multiple stepwise regression results showed that medical insurance type,age,hope score,tumor histological grade and quality of life score were included in the regression equation of the scores of treatment decision participation attitude of breast cancer patients undergoing chemotherapy,which accounted for 60.5%of the total variation of treatment decision participation attitude of breast cancer patients undergoing chemotherapy.Hope score,education level,age,tumor histological grade,hospitalization frequency and quality of life score were included in the regression equation of actual degree of participation in treatment decision-making of breast cancer chemotherapy patients,which accounted for 65.7%of the total variation in actual degree of participation in treatment decision-making of breast cancer chemotherapy patients.Conclusions1.This study shows that patients actively participate in treatment decision-making,but the actual degree is not high.This also indicates that the importance of patients’ participation in decision-making is not fully understood in clinical practice,and we still have a long way to go in promoting patients’participation in decision-making.We should achieve the tripartite cooperation between doctors and patients,play the role of multidisciplinary cooperation,and explore the patient decision-making participation mode suitable for clinical work step by step.2.Understanding the current situation of breast cancer chemotherapy patients’participation in decision-making can help medical staff assess patients’ needs more objectively,help patients choose the best treatment plan,improve patients’ satisfaction with medical treatment.Through the discussion of the influencing factors of patients’participation in decision-making,it also provides the direction for the clinical designation of targeted intervention measures.At the same time,improving patients’decision-making participation in clinical work is also helpful to improve patients’hope level and quality of life. |
PDF Full Text Request