Punnett Grant, Perry Melissa, Eastwood Charlotte, Green Laura, Walter Florian, Yorke Janelle
The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK; Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK.
The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK.
Eur J Oncol Nurs. 2025 Feb;74:102762. doi: 10.1016/j.ejon.2024.102762. Epub 2024 Dec 7.
In decisions relating to cancer treatment, the risks and benefits of treatment and the patient's preferences must be considered to ensure concordance with goals of care. Shared decision making (SDM) can facilitate these discussions and is associated with reduced decision conflict. This study aimed to characterise decision making for advanced cancer patients at a UK tertiary cancer centre and identify who may be at risk of suboptimal SDM and increased decision conflict.
Participants completed the SDM-Q-9, decision conflict and decision self-efficacy scale following a consultation where an advanced cancer treatment decision was made. Pearson's chi-square test identified patient characteristics associated with SDM-Q-9, decision self-efficacy and decision conflict score categories; odds ratios were calculated to determine which patients were at increased probability of experiencing suboptimal SDM, low decision self-efficacy or high decision conflict.
Participant's (n = 211) scores indicated predominantly high SDM, high decision self-efficacy and low decision conflict. Patient gender and the presence of an informal caregiver in consultation were significantly associated with SDM-Q-9 score category (p > 0.05). Female patients (OR = 2.466, 95% CI: 1.223-4.974) and those attending consultations alone (OR = 0.440, 95% CI: 0.222-0.874) had greater odds of reporting lower SDM scores.
High SDM scores indicate either effective SDM behaviours or satisfaction with care biasing responses. Greater support to engage with SDM is required for female patients and those who attend alone in advanced cancer treatment decision consultations.
在有关癌症治疗的决策中，必须考虑治疗的风险和益处以及患者的偏好，以确保与护理目标相一致。共同决策（SDM）有助于进行这些讨论，并与减少决策冲突相关。本研究旨在描述英国一家三级癌症中心晚期癌症患者的决策过程，并确定哪些患者可能存在SDM欠佳和决策冲突增加的风险。
参与者在做出晚期癌症治疗决策的会诊后，完成SDM-Q-9、决策冲突和决策自我效能量表。Pearson卡方检验确定与SDM-Q-9、决策自我效能和决策冲突得分类别相关的患者特征；计算优势比以确定哪些患者经历欠佳SDM、低决策自我效能或高决策冲突的可能性增加。
参与者（n = 211）的得分主要表明SDM水平高、决策自我效能高和决策冲突低。患者性别和会诊时是否有非正式护理人员与SDM-Q-9得分类别显著相关（p > 0.05）。女性患者（OR = 2.466，95% CI：1.223 - 4.974）和独自参加会诊的患者（OR = 0.440，95% CI：0.222 - 0.874）报告较低SDM得分的可能性更大。
高SDM得分表明要么是有效的SDM行为，要么是对护理的满意度使反应产生偏差。在晚期癌症治疗决策会诊中，女性患者和独自就诊的患者需要更多支持以参与SDM。
