School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
Sci Rep. 2023 Aug 5;13(1):12715. doi: 10.1038/s41598-023-39280-6.
Decisional conflict might occur during shared decision-making (SDM) because immunotherapy is a rather novel treatment option for patients with cancer. To explore the prevalence and severity of physical and psychological symptoms and the effort invested in SDM in relation to decisional conflict among patients with cancer undergoing immunotherapy combined with chemotherapy or targeted therapy. This was a cross-sectional survey study. The SURE version of the Decisional Conflict Scale was used to screen cancer patients' decisional conflict status. Demographic or clinical characteristics, physical symptoms and psychological distress; efforts invested in the SDM process were also assessed as potential factors related to decisional conflict. One hundred seventeen patients surveyed, the prevalence of fatigue (79.5%), sleep disturbance (78.6%), poor appetite (67.5%), and pain (58.1%) symptoms were high and the severity was at moderate levels. The prevalence of pruritus (40.2%), rash (34.2%), dry skin (41.9%), and diarrhea (17.1%) symptoms were low and the severity was at mild levels. 65.8% of patients reported uncertainty, with mild to moderate levels. Furthermore, 97.4% of the patients made some effort in SDM, and the effort level was moderate (mean: 5.56 ± 2.02). 64.1% of patients were certain that immunotherapy was the best option. Age, uncertainty, and effort in the SDM process were major factors related to decisional conflict. We observed that older patients (age: ≥ 65) and those with higher uncertainty levels and less effort in SDM reported higher levels of decisional conflict. Future studies should explore older patients' decisional related needs of immunotherapy. Interventions should be designed to reduce the uncertainty experienced by patients with cancer and enhance their understanding of immunotherapy to enable them to take more effort in the SDM process.
决策冲突可能会在共同决策（SDM）过程中出现，因为免疫疗法对于癌症患者来说是一种相对较新的治疗选择。本研究旨在探讨癌症患者在接受免疫联合化疗或靶向治疗时，与决策冲突相关的身体和心理症状的严重程度、发生率以及SDM 过程中投入的精力。这是一项横断面调查研究。使用决策冲突量表的 SURE 版本筛查癌症患者的决策冲突状况。还评估了人口统计学或临床特征、身体症状和心理困扰以及 SDM 过程中投入的努力等因素，这些因素可能与决策冲突相关。对 117 名接受调查的患者进行分析，发现疲劳（79.5%）、睡眠障碍（78.6%）、食欲不振（67.5%）和疼痛（58.1%）等症状的发生率较高，且症状严重程度处于中等水平。瘙痒（40.2%）、皮疹（34.2%）、皮肤干燥（41.9%）和腹泻（17.1%）等症状的发生率较低，且症状严重程度处于轻度水平。65.8%的患者报告存在不确定性，且处于轻度至中度水平。此外，97.4%的患者在 SDM 中投入了一定的精力，且精力水平处于中等水平（平均：5.56±2.02）。64.1%的患者确定免疫疗法是最佳选择。年龄、不确定性和 SDM 过程中的努力是与决策冲突相关的主要因素。我们观察到，年龄较大的患者（年龄：≥65 岁）和那些不确定性水平较高、在 SDM 中投入精力较少的患者报告的决策冲突水平较高。未来的研究应探讨老年患者对免疫治疗的决策相关需求。应设计干预措施来降低癌症患者的不确定性，并增强他们对免疫治疗的理解，以便他们在 SDM 过程中投入更多的精力。
