| ObjectiveIn order to explore the status of treatment decision conflict in early stage patients with primary liver cancer(PLC)and the preparation of existing treatment & nursing education materials to help patients make decision,this study was based on early research results and planned to introduce and chinesize Decision Conflict Scale(DCS)and Preparation Decision Making(PrepDM),to develop Patient Decision Aids(PDAs)which is dominated by nurses and educated patients jointly with doctors.Furthermore,in order to verify the effects of PDAs,clinical trials were designed.By providing PDAsfor early stage PLC patients with awareness of diagnoses and willingness to participating in treatment decisions,to protect the legitimate rights and interests of patientsand to promote the consistency in patients’ attitudes and the actual participation.On the other hand,to guide the patient’s to participate in decision making rationally and to improve the quality of treatment decision making.Methods1.According to the standard process of chinesization,we introduced the DCS which was developed by O’Connor and the PrepDM developed by Bennett.By convenient sampling,168 cases and 132 cases in a certain tertiary hepatobiliary specialized hospital in Shanghai were separately elected to complete the survey.SPSS18.0 was used to test the consistency of the scale,KMO and principal component analysis to verify the reliability and validity of the scales.Descriptive statistics and spearman correlation analysis were used to obtain the role of education material in preparing patients for decision and the decision conflict status of early-stage PLC patients.2.Based on literature review and the status of preparation and decision conflict in early-stage PLC patients,we developed PDAs protocols which were guided by the theory of Charles’ s Shared Decision Making Therory,theOttawa Decision Support Framework and the Model of Evidence Based Practice.Through two rounds of expert meetings and clinical practice,to revise the protocol and to make it more adaptable to meet the needs of patients.3.By convenient sampling,105 cases in a certain tertiary hepatobiliary specialized hospital in Shanghai were recruited as control group from 1stMay to 31 stAug.in 2016.95 cases from 1st Sep.to 31 st Dec.in 2016 as intervention group.To verify the effects of the PDAs protocol by Clinical Trials in the early stage of PLC patients with awareness of diagnoses and willingness to participate in treatment decision making.SPSS18.0 was used to do descriptive statistics,t test,chi square test,spearman correlation analysis and to evaluate two groups in the consistency about patients’ attitudes and the actual participation in treatment decisions,anxiety and depression,treatment-related knowledge,decision conflict in the decision making,preparation for treatment decisions and satisfaction.4.To explore the patients’ experience of using PDAs,a qualitative research was performed.By purposive sampling and maximum differential sampling,semi-structured interview was used according to the outline of interviews until the data was saturated.Using Colaizzi qualitative data analysis method,to explore the experience of patients and their attitude towards treatment PDAs.Results1.Chinese version of decision conflict scale(C-DCS)Cronbach’s a coefficient is 0.906,KMO value is 0.842,content validity is 0.95.The score of a survey in 168 patients with early-stage PLC is(27.13 ± 17.38),48.6% patients had treatment decision conflict.Chinese version of preparation for decision making(C-PrepDM)Cronbach’s a coefficient is 0.946,KMO value is 0.928,content validityis 0.966.The score of a survey in132 patients with early-stage PLC is(64.36 ±18.07),52.4% patients believed that the existing treatment &nursing education materials failed to prepare patients to participate in treatment decision-making.2.Through two rounds of experts meetings and clinical practice,we developed and revised PDAs protocol to make it more adaptable to meet patients’ needs.The protocol included the composition and responsibilities of decision-making team,decision making flow chart and implementation checklist.PDAs Kit contained patients’ decision demands and preference evaluation table,Question Prompt List,Treatment Option Grids and decision support Handbook.Severalhigh reliability and validity assessment scaleswere selected to measure the founction of PDAs and the quality of participating in treatment decision making.3.By non parallel controlled clinical trial,PDAs can effectively promote patients with early-stage PLC participate in treatment decisions.32.4%of the control group participated in the treatment decision-making,the difference between the attitudes and actual participation was statistically significant(p<0.001).96.8% of the intervention group participated in decision making,the difference was not statistically significant(p=0.063).Compared with the control group,there were significant differences between the two groups in decision conflicts,preparation for decision making,decision making satisfaction and knowledge(P<0.01).After intervention,there was no significant difference in the scores of anxiety and depression between the two group(p>0.05).Before and after the intervention,the difference of anxiety score was statistically significant(P<0.01),but the difference between depression was not statistically significant(p>0.05).4.Through qualitative interviews and in-depth analysis of the data,a tree structure diagram of early PLC patients involved in the decision making experience were mapped.Four primary subjects were obtained,that is,the mental process of early PLC patients to participate in the decision-making process,the factors that promote the patients to participate in decision-making and the benefits of patients’ participation in treatment decision making.Involved in the decision-making processseparated out 3 sub themes,from the initial confusion stage to the gradual acceptance stage,and finally went to growth stage.The factors that promoted the patients’ decision-making included 6 sub themes,good personality characteristics,reasonable and effective response,family support,trust in medical institutions,doctor-patient interaction and communication decision support resources.The results of patient participation in treatment decisions included 3 sub themes,beneficial to patients,beneficial to the family,and beneficial to the medical institutions.Conclusions1.The study introduced and chinesized the C-DSC and theC-PrepDM with good reliability and validity in early-stage PLC patients with awareness of diagnoses and willingness to participate in treatment decision-making.48.6% patients with early-stage PLC have treatment decision conflict.52.4% patients believed that the existing treatment &nursing education materials failed to prepare patients to participate in treatment decision-making.2.PDAs for early-stage PLC patients can effectively promote the realization of the consistency in patients’ attitudes and the actual participation in treatment decisionmaking.Furthermore,it can improve patients’ treatment-related knowledge,preparation for decision,treatment decision satisfaction and reduce decision conflict.3.Early-stage PLC patients who actually involved in treatment decision-making did not get high scores in the survey of anxiety and depression.On the contrary,PDAs can reduce their anxiety by improving patients’ treatment-related knowledge and the preparation to make decision.4.Patients’ participation in treatment decision making is the trend of world in the field of health care.Because of medical protective culture in domestic,Patients’ participation in treatment decision makingare not well developed,lacking of patient decision aid forthe treatment of cancer.Based on specialized hepatobiliaryhospital and National Science Center for Liver Cancer,we developed decision aid kits and multidisciplinary intervention model intreatment decision-making.Early-stage informed PLC patients were recruited as the research objects,the decision aid kits and multidisciplinary intervention model were confirmed scientifically and feasibly for PLC patients.In the future,in order to protect the Rights of patients and help them to achieve "No Decision About Me Without Me",we will continuously revise the decision aid kits and multidisciplinary intervention model,and apply this model gradually to other patients with the demands of participation in treatment decision making. |
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