Development And Application Of A Decision Aid For Postoperative Adjuvant Chemotherapy In Breast Cancer Patients

Objectives1.To construct a decision aid for postoperative adjuvant chemotherapy for breast cancer based on International Patient Decision Aid Standards and the Ottawa Decision Support Framework through evidence integration,expert consultation and user adaptation.2.To apply the decision aid for postoperative adjuvant chemotherapy for breast cancer patients,guide patients to participate in the decision-making process,and evaluate the intervention effect of the decision aid.Methods1.A preliminary version of a decision aid for postoperative adjuvant chemotherapy for breast cancer patients,guided by the Ottawa Decision Support Framework theory and combined with evidence integration;through two rounds of expert consultation and user debugging,the initial version of the decision aid was revised and improved to form the final version of the decision aid for postoperative adjuvant chemotherapy for breast cancer patients.2.Fifty-nine patients who were first diagnosed with breast cancer disease and required postoperative adjuvant chemotherapy in a hospital in Jiangsu Province from May to December 2022 were selected as the study subjects.Patients in the control group received conventional treatment and nursing education,and patients in the intervention group were given postoperative adjuvant chemotherapy decision aid on the basis of conventional treatment and nursing education.General information questionnaire,patient willingness/actual participation in treatment decision-making questionnaire,patient health questions,7-item generalized anxiety disorder scale,preparation for decision making scale,decision conflict scale,the 9-item shared decision making questionnaire,and decision regret scale were used as instruments to assess the study subjects.The study data were double-checked,entered into Excel,and analyzed using SPSS 26.0 statistical software for data analysis.Results1.Nineteen studies from China,the Netherlands,the United States,Australia,and Canada were included in the systematic review;presentations included brochures,decision panels,phone apps,videos,and websites;content included breast reconstruction,fertility preservation,choice of surgical modality,breast cancer screening,and choice of chemotherapy regimen;study years were 2003 to 2022;outcome indicators included knowledge level,decision satisfaction,anxiety and depression,decision conflict,and decision regret.2.Through expert consultation and user debugging,a decision aid with 8 primary and 22 secondary indicators for postoperative adjuvant chemotherapy for patients with breast cancer was developed.The results of expert correspondence showed that the participating experts were authoritative,motivated and focused,and the preexperimental results showed that the decision aid was informative,easy to understand and practical.3.The use of the decision aid for postoperative adjuvant chemotherapy for breast cancer patients helped to improve the quality of patients’ decision making and alleviate anxiety.Patients in the intervention group after the intervention were statistically different(P<0.05)compared to the control group in terms of decisional conflict(22.56±6.23),preparation for decision making(80.79±7.08),participation in treatment decisionmaking actual(1.33±0.22),decisional regret(34.71±10.27),and 7-item generalized anxiety disorder(4.82±1.96);however,there were no statistically significant differences between the intervention and control groups in terms of 9-item shared decision making and patient health questions scores(P values of 0.053 and 0.546,respectively).The results of the intra-group comparison between the two groups of patients showed that the difference between patients’ willingness to participate in treatment decision making and their actual scores in the intervention group was not statistically significant(P>0.05);the difference between patients’ willingness to participate in treatment decision making and their actual scores in the control group was statistically significant(P<0.01),and patients’ participation in treatment decision making was actually lower than their willingness to participate in treatment decision making.There was a statistically significant difference(P<0.05)in the intra-group comparison of the scores of the preparation for decision making between patients in the intervention and control groups.Conclusion1.In our study,the Ottawa Decision Support Framework was used as the theoretical framework,and the decision aid for postoperative adjuvant chemotherapy for breast cancer patients was initially constructed based on a review of relevant literature,and the final version of the decision aid for postoperative adjuvant chemotherapy for breast cancer patients was modified and improved through expert consultation and user debugging.The research method is scientific,and the content of the tool is informative and usable.2.The use of the postoperative adjuvant chemotherapy decision aid for breast cancer patients helps to improve the quality of patients’ decision making,including reducing the level of decisional conflict,improve their readiness to make decisions,promoting patients’ participation in treatment decisions,and reducing patients’ long-term decisional regret.Also,the use of decision aid for breast cancer patients can effectively reduce patients’ anxiety.