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观察常规放射治疗癌症护理中共享决策的实施:一项探索性纵向问卷调查研究。

Observing the Implementation of Shared Decision-making in Routine Radiotherapy Cancer Nursing: An Explorative Longitudinal Questionnaire Study.

机构信息

Author Affiliations: Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, (Dr Efverman); and Department of Quality and Development, Södersjukhuset, Stockholm (Mrs Bergius Axelsson).

出版信息

Cancer Nurs. 2021;44(5):369-377. doi: 10.1097/NCC.0000000000000830.

Abstract

BACKGROUND

Healthcare professionals have driven decision-making in the past. However, shared decision-making has the potential to increase quality of care.

OBJECTIVE

To determine to what degree patients undergoing routine pelvic radiotherapy care perceive decision-making as being shared between patient and healthcare professionals.

METHODS

This exploratory longitudinal study covered 193 patients undergoing pelvic radiotherapy, mostly women (n = 161 [84%]) treated for a gynecological (n = 132 [68%]) or colorectal (n = 54 [28%]) cancer. We collected data regarding self-perceived level of shared decision-making at the start of radiotherapy and quality of life (QoL) (91%-95% response rate per week) during the radiotherapy period.

RESULTS

The patients reported that they shared the decision-making with the healthcare professionals much (n = 137 [71%]), moderately (n = 33 [17%]), a little (n = 12 [6%]), or not at all (n = 11 [6%]). Male patients (P = .048), patients who did not live with their partner (P = .034), patients with higher education (P = .043), and patients with low functional capacity (P = .018) perceived lower levels of shared decision-making. A higher level of shared decision-making was related to higher QoL at baseline and during the first to third weeks of radiotherapy (P ranged from .001 to .044).

CONCLUSIONS

Almost 9 of 10 patients reported that they shared the decision-making moderately or much with the healthcare professionals. The study identified subgroups perceiving lower levels of shared decision-making and found that a higher level of shared decision-making was related to better QoL.

IMPLICATIONS

Healthcare professionals may need to pay extra attention to patients who may perceive that they share decision-making to a low extent.

摘要

背景

过去,医疗保健专业人员一直主导决策。然而,共同决策有可能提高医疗质量。

目的

确定在接受常规盆腔放疗护理的患者中,患者对医患之间共同决策的看法程度。

方法

本探索性纵向研究共纳入 193 名接受盆腔放疗的患者,其中大多数为女性(n = 161 [84%]),治疗的疾病包括妇科肿瘤(n = 132 [68%])或结直肠肿瘤(n = 54 [28%])。我们在放疗开始时收集了患者对共同决策的自我感知程度的数据,以及放疗期间的生活质量(QoL)数据(每周 91%-95%的回复率)。

结果

患者报告说,他们与医疗保健专业人员共同决策的程度很高(n = 137 [71%])、中等(n = 33 [17%])、较低(n = 12 [6%])或几乎没有(n = 11 [6%])。男性患者(P =.048)、与伴侣不同居的患者(P =.034)、受教育程度较高的患者(P =.043)和功能状态较差的患者(P =.018),其共同决策程度较低。更高程度的共同决策与基线和放疗第一至第三周的 QoL 更高相关(P 范围从.001 到.044)。

结论

近 10 名患者中有 9 名报告说,他们与医疗保健专业人员中度或高度共同决策。本研究确定了感知共同决策程度较低的亚组患者,并发现更高程度的共同决策与更好的 QoL 相关。

意义

医疗保健专业人员可能需要特别关注那些可能认为自己参与决策程度较低的患者。

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