School of Nursing, Pontifical Catholic University of Chile, Santiago, Chile
Instituto Oncologico Fundacion Arturo Lopez Perez, Providencia, Santiago, Chile.
BMJ Open. 2023 Jul 20;13(7):e074111. doi: 10.1136/bmjopen-2023-074111.
Chile is committed to actively involving patients in their healthcare. However, little is known about how this is translated into clinical encounters. Breast cancer (BC) is the first cause of cancer-related death in Chilean women. National policy guarantees standard care, and treatment decisions should be made along this process that can have long-term consequences for women. So, BC is a particularly well-suited case study to understand the complexity of patient participation in decision-making.
To identify the factors that affect the active involvement of patients in the BC treatment decision-making process, considering the perspectives and practices of health professionals and women facing the disease.
We will conduct a mixed-method study through a convergent parallel design in three stages: (1) A qualitative study: non-participant observation of the tumour board (TB) meetings; semi-structured interviews with key informants from TBs; documentary analyses; semi-structured interviews with women facing BC; and non-participant observations of clinical encounters; (2) a cross-sectional study with 445 women facing BC stages I-III from three hospitals in Santiago, Chile. We will measure the level of expected participation, experienced participation, decisional conflict, quality of life (QoL) and satisfaction with healthcare. Descriptive analysis will be performed, and multivariable binary logistic regression models will be adjusted to identify factors associated with high levels of QoL or satisfaction; (3) an integration study will bring together the data through a joint display technique.
The study has been conceived and will be conducted according to international and local agreements for ethical research. Ethical approval has been granted by two Ethics Committees in Chile.The results will be disseminated to scientific and lay audiences (publications in scientific journals and conferences, seminars and a website for plain language dissemination).
智利致力于积极让患者参与自身的医疗保健。然而，对于这一举措如何转化为临床诊疗，我们知之甚少。乳腺癌（BC）是智利女性癌症相关死亡的首要原因。国家政策保障标准护理，且治疗决策应在此过程中做出，这可能会对女性产生长期影响。因此，BC 是一个特别适合的案例研究，可以帮助我们了解患者参与决策制定的复杂性。
确定影响患者积极参与乳腺癌治疗决策过程的因素，同时考虑卫生专业人员和面临该疾病的女性的观点和实践。
我们将通过三阶段的收敛平行设计进行混合方法研究：（1）定性研究：肿瘤委员会（TB）会议的非参与性观察；TB 关键信息提供者的半结构化访谈；文献分析；面临 BC 的女性的半结构化访谈；以及临床诊疗的非参与性观察；（2）一项来自智利圣地亚哥三家医院的 445 名 I-III 期乳腺癌女性的横断面研究。我们将测量预期参与度、实际参与度、决策冲突、生活质量（QoL）和对医疗保健的满意度。将进行描述性分析，并调整多变量二元逻辑回归模型，以确定与高 QoL 或满意度相关的因素；（3）整合研究将通过联合展示技术汇集数据。
该研究是根据国际和当地的伦理研究协议构思和进行的。智利的两个伦理委员会已经批准了该研究。研究结果将向科学和非专业受众传播（在科学期刊和会议上发表、研讨会和一个普通语言传播网站）。
