Lu Ting, Xu Junxia, Cao Qingrong, Zhang Jing, Chen Jian, Lin Lin, Shan Benjie, Wei Jie
Department of Comprehensive Oncology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230000, Anhui, China.
J Cancer Educ. 2025 May 15. doi: 10.1007/s13187-025-02646-7.
This study aimed to develop and validate a culturally adapted, nurse-led shared decision-making question prompt list (SDM-QPL) to enhance decision-making support for Chinese breast cancer patients considering clinical trials. A mixed-methods approach was employed, involving a systematic literature review (52 studies), semi-structured interviews with 15 patients and 8 healthcare providers, a three-round Delphi consensus with 13 experts, and psychometric testing. The process yielded a 40-item QPL tailored to cultural needs, such as familial decision-making and Traditional Chinese Medicine (TCM) use. The SDM-QPL, organized into five modules, achieved strong expert consensus (Kendall's W = 0.82, P < 0.001) and retained 92% of nurse-sensitive items. Psychometric evaluation confirmed high validity (S-CVI/Ave = 0.89) and reliability (Cronbach's α = 0.91). Qualitative analysis identified key barriers: information overload (93.3%), risk misperceptions (86.7%), and nursing communication gaps (80.0%). This nurse-led SDM-QPL, grounded in Elwyn's Three-Talk Model, addresses China's unique cultural and structural challenges, fostering triadic dialogue among patients, families, and providers. The tool empowers oncology nurses to bridge communication gaps, improve trial participation equity, and support patient-centered care in collectivist settings.
本研究旨在开发并验证一种经过文化调适、由护士主导的共同决策问题提示清单（SDM-QPL），以加强对考虑参加临床试验的中国乳腺癌患者的决策支持。采用了混合方法，包括系统文献综述（52项研究）、对15名患者和8名医疗服务提供者进行半结构化访谈、与13名专家进行三轮德尔菲共识法以及心理测量测试。该过程产生了一份针对文化需求（如家庭决策和中医使用）量身定制的包含40个条目的QPL。SDM-QPL分为五个模块，达成了强烈的专家共识（肯德尔和谐系数W = 0.82，P < 0.001），并保留了92%的护士敏感条目。心理测量评估证实其具有高有效性（S-CVI/Ave = 0.89）和可靠性（克朗巴哈α系数 = 0.91）。定性分析确定了关键障碍：信息过载（93.3%）、风险认知错误（86.7%）和护理沟通差距（80.0%）。这种由护士主导的SDM-QPL以埃尔温的“三谈”模型为基础，应对了中国独特的文化和结构挑战，促进了患者、家庭和医疗服务提供者之间的三方对话。该工具使肿瘤护理人员能够弥合沟通差距，提高试验参与的公平性，并在集体主义环境中支持以患者为中心的护理。
