Study On The Involvement Of Patients With Colorectal Cancer In Clinical Treatment Decision-making

Objective:The study combined with quantitative research and qualitative research method to explore the status quo of colorectal cancer patients in clinical decision making,explore the influencing factors in patients to participate in decision-making and the real decision-making process,in order to participate in clinical decision scheme for colorectal cancer patients to provide the theoretical basis,the optimization of clinical decision for medical personnel to provide certain referencemethods:(this study consists of two parts)1.quantitative study: A total of 300 patients diagnosed with colorectal cancer in two level-A hospitals in Xi ’an were investigated by convenience sampling method,with July2020 to October 2020.The survey tools included a questionnaire on general conditions and a questionnaire on patients’ participation in treatment decision-making.SPSS26.0was used to collate and analyze the results.Statistical methods included statistical description,Kappa consistency test,chi-square test,and univariate analysis.The results showed that the degree of patients with colorectal cancer expected to participate in clinical decision-making,the degree of actual participation in clinical decision-making,the consistency of the two and the influencing factors.2.qualitative study: According to the literature review,the interview outline was formulated.On the basis of quantitative study,12 patients with poor clinical decision consistency were selected for face-to-face semi-structure.Analyze the actual process of patients’ participation in clinical decision-making,the specific content and characteristics of each link,and clarify the needs of patients’ participation in decision-making.results: Among the 290 subjects investigated in this study,223 cases(76.9%)had positive participation attitude and 67 cases(23.1%)had negative participation attitude,with a total mean score of(1.37±0.41).96 cases(33.1%)had a high degree of actual participation in decision-making,and 194 cases(66.9%)had a low degree of participation,with a total mean score of(1.82±0.41).The Kappa value of the attitude of patients to participate in clinical decision-making and the actual degree of participation was 0.192.Except for item 8(I choose among various treatment options),item 11(I decide the treatment plan by myself)and item 12(the doctor decides my treatment plan),the Kappa value was > 0.4.The Kappa values were 0.566,0.591 and 0.602,respectively,and the Kappa values of other items were all less than 0.4.However,the values of item 8,item 11 and item 12 kappa are still below the ideal level of 0.75.According to the statistical analysis,the factors affecting the attitude of patients to participate in clinical decision-making included gender,educational level,long-term residence,and whether they were treated for the first time.Among them,the participation attitude of women was higher than that of men(P =0.029),the participation attitude of those with high education level was higher than that of those with low education level(P =0.016),the participation attitude of those living in urban areas was higher than that of those living in rural areas(P=0.034),and the participation attitude of those receiving first treatment was higher than that of those not receiving first treatment(P =0.037).The difference was statistically significant(P < 0.05).Factors affecting the actual participation of patients with colorectal cancer included employment status,long-term residence,and knowledge of the diagnosis.The actual participation degree of active patients was higher than that of retired and other patients(P =0.041).The actual participation degree of urban patients was higher than that of rural patients(P =0.029).The actual participation degree of patients with knowledge of diagnosis was higher than that of patients without knowledge of diagnosis(P =0.020),and the difference was statistically significant(P < 0.05).Three themes and ten sub-themes were extracted from the interviews with patients with colorectal cancer before,during and after decision making.Before decision-making,there are three subthemes: fear of the environment,need to build trust relationship,and desire for attention.The decision-making process includes four subthemes: information asymmetry,seeking social support,psychological dependence,and the need for knowledge related to surgery.Post-decision making includes three sub-themes: negative coping,passive acceptance and surgical-related knowledge needs.conclusions: Chinese patients with colorectal cancer have a positive attitude towards decision-making,but their actual participation is low.The consistency between the attitude of patients and the actual degree of participation in clinical decision-making was poor.The factors affecting the attitude of patients involved in decision-making included education level,gender,long-term residence,whether the first treatment;Factors affecting the actual participation of patients included long-term residence,on-the-job status,and knowledge of diagnosis;In the qualitative study of patients’ participation in decision-making,there were three subthemes: fear and tension of unfamiliar environment,desire to establish trust relationship with doctors,and desire for attention before decision-making.Topic 2: there were four subthemes in the decision-making process:information asymmetry,seeking social support,psychological dependence and the need for surgical knowledge.Topic 3 had three subthemes: negative psychological appearance,passive acceptance and active seeking of home nursing knowledge after decision making.