Office of Research Management and Education Administration, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, China.
School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, 510275, Guangdong, China.
Support Care Cancer. 2020 Nov;28(11):5353-5361. doi: 10.1007/s00520-020-05391-3. Epub 2020 Mar 5.
Patient-centered care (PCC) and shared decision-making (SDM) is advised within the English medical literature for its positive impact. The benefits of such approaches are said to foster increased trust, patient decision satisfaction, and even better outcomes. Looking at a Chinese cancer hospital, this research sought to understand how surgical decision-making was made among colorectal cancer patients.
Observations (n = 36) and semi-structured interviews (n = 24) were conducted with patients and family members.
In the observations, 69.4% of the participating families made the decision to undergo surgery at the end of the consultation. In the interviews, three main themes emerged in regard to the characteristics in the family decision-making model, and they included three structural elements: the patient's sick role, family functional structure, and control of information.
This study showed that the Chinese decision-making model is different from the western SDM model. In the Chinese context, family members dominated the decision-making process which raised concerns around informed consent. This may benefit patients insofar as receiving timely treatment in the short term but at the same time may be at the expense of limiting patient's autonomy. The promotion of a new model or a model encompassing family-centered care values may be more appropriate in clinical practice in China that can address the issues around informed consent.
在英文医学文献中，建议采用以患者为中心的护理（PCC）和共同决策（SDM），因为它们具有积极影响。据称，这些方法的好处可以促进增加信任、患者决策满意度，甚至更好的结果。本研究以一家中国癌症医院为研究对象，旨在了解结直肠癌患者的手术决策是如何做出的。
对患者及其家属进行了观察（n=36）和半结构化访谈（n=24）。
在观察中，69.4%的参与家庭在咨询结束时决定接受手术。在访谈中，家庭决策模式的特征出现了三个主要主题，它们包括三个结构要素：患者的病患角色、家庭功能结构和信息控制。
本研究表明，中国的决策模式与西方的 SDM 模式不同。在中国语境下，家庭成员主导决策过程，这引发了知情同意方面的问题。从短期来看，这可能使患者受益，因为他们可以及时得到治疗，但同时也可能以限制患者自主权为代价。在中国的临床实践中，推广一种新的模式或一种包含以家庭为中心的护理价值观的模式可能更合适，可以解决知情同意方面的问题。
