Zhang Qianqian, Gu Xinyue, Liu Shuangyuan, Fu Rong, Wang Ying, Hegarty Josephine, Zhu Pingting, Ge Jingwu
Department of Anesthesia and Perioperative Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
School of Nursing, Yangzhou University, Yangzhou, Jiangsu, People's Republic of China.
JAMA Otolaryngol Head Neck Surg. 2024 Sep 19;150(11):952-9. doi: 10.1001/jamaoto.2024.2718.
Internationally, active surveillance has been shown to be beneficial and safe in the management of low-risk papillary thyroid microcarcinomas. However, choosing active surveillance is a difficult treatment decision for patients with low-risk papillary thyroid microcarcinomas.
To identify and analyze the antecedents and mediating processes of decisional conflicts when patients consider active surveillance as an alternative to surgery.
DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, semistructured interviews were conducted between April 2023 and December 2023 at 3 tertiary hospitals in China. Thirty-one participants who were diagnosed with low-risk papillary thyroid microcarcinomas, who had experienced considering active surveillance as an alternative to surgery and who scored above 25 on the decision conflict scale were purposively recruited. Inductive content analysis led to emergent themes. Data analysis was performed from April 2023 to February 2024. Methods used to protect the trustworthiness of the study results included audit trails and member checks.
Patients' experience of decisional conflicts and the antecedents and mediating processes relating to these decisional conflicts.
Among 31 participants (median [range] age, 39.2 [22-63] years; 22 [71%] were female and 9 [29%] were male), 3 themes were classified: (1) decisional conflicts in decision preparation, (2) decisional conflicts in decision-making, and (3) decisional conflicts in decision implementation. The patient's experiences of decisional conflicts were diverse and occurred throughout the entire decision-making process. The antecedents of the decisional conflicts included personal influencing factors, system-level influencing factors, and the relational-situational context. Patients with low-risk papillary thyroid microcarcinomas interacted with these antecedents in the process of decision-making and eventually failed to mediate, leading to decisional conflicts.
This qualitative study found that patients with low-risk papillary thyroid microcarcinomas experienced clinically significant decisional conflicts and experienced considerable challenges and psychological problems in decision-making. The antecedents of decisional conflicts and accompanying mediating processes can provide guidance for individuals, health care professionals, and health care systems to provide decision support for patients with low-risk papillary thyroid microcarcinomas.
在国际上，主动监测已被证明在低风险甲状腺乳头状微小癌的管理中是有益且安全的。然而，对于低风险甲状腺乳头状微小癌患者而言，选择主动监测是一个艰难的治疗决策。
识别并分析患者在考虑将主动监测作为手术替代方案时决策冲突的前因及中介过程。
设计、背景与参与者：在这项定性研究中，于2023年4月至2023年12月期间在中国的3家三级医院进行了半结构化访谈。有目的地招募了31名被诊断为低风险甲状腺乳头状微小癌、曾考虑过将主动监测作为手术替代方案且在决策冲突量表上得分高于25分的参与者。采用归纳性内容分析法得出新出现的主题。数据分析于2023年4月至2024年2月进行。用于保护研究结果可信度的方法包括审计追踪和成员核对。
患者的决策冲突体验以及与这些决策冲突相关的前因和中介过程。
在31名参与者中（年龄中位数[范围]为39.2[22 - 63]岁；22名[71%]为女性，9名[29%]为男性），归纳出3个主题：(1)决策准备阶段的决策冲突，(2)决策制定阶段的决策冲突，以及(3)决策实施阶段的决策冲突。患者的决策冲突体验多种多样，且贯穿于整个决策过程。决策冲突的前因包括个人影响因素、系统层面影响因素以及关系情境。低风险甲状腺乳头状微小癌患者在决策过程中与这些前因相互作用，最终未能进行调解，从而导致决策冲突。
这项定性研究发现，低风险甲状腺乳头状微小癌患者经历了具有临床意义的决策冲突，并且在决策过程中面临相当大的挑战和心理问题。决策冲突的前因及伴随的中介过程可为个人、医疗保健专业人员和医疗保健系统为低风险甲状腺乳头状微小癌患者提供决策支持提供指导。
