Construction And Application Of An M-health Based Treatment Decision Aids Platform For Primary Liver Cancer Patients

ObjectivePatients with primary liver cancer（PLC）would get benefit from patient decision aids（PDAs）during the shared decision making（SDM）.We aim to explore the information needs of PLC patients in the stage of participating in SDM under mobile health（m-Health）through two steps.Firstly,individual interviews and expert group discussions were conducted to identify the specific needs and status of PLC patients participating in SDM,in order to draft the framework and decide contents of the m-Health based decision aids program.Secondly,based on this,we constructed and developed a We Chat mini program named“Treatment Decision Aids Platform”for PLC patients,and then to evaluate the effectiveness,thus to increase the sense of participation in SDM,to improve the efficiency of SDM,to achieve good medical outcomes,and further to promote the relationship between doctors and PLC patients,which is worthy of clinical promotion.MethodsThe study is divided into three parts:1.Construction of a patient decision aids based on m-Health for PLC patients during the SDM.（1）Through qualitative research,we conducted semi-structured interviews with 14PLC patients to explore their information needs and preference in SDM,the ways and sources of obtaining information support to participate in SDM,and the views on m-Health.（2）Based on the literature review and qualitative interview,the decision aids project for PLC patients based on m-Health was constructed,and the project was revised by expert meeting to form the final project.2.Development of“Treatment Decision Aids Platform”for PLC patients based on We Chat Mini Program.Based on the m-Health decision aids project for PLC patients obtained from previous phases of research,apply agile development model to develop the“Treatment Decision Aids Platform”.Three researchers performed functional tests during the development process.After the“Platform”development was completed,five informed PLC patients and three family members were included in the functional testing and the program was initially evaluated.3.Effectiveness evaluation of the“Treatment Decision Aids Platform”for PLC patients（1）The decision self-efficacy scale（DSES）developed by O’Connor and the satisfaction with decision scale（SWDS）developed by Holmes-Rovner were introduced in our study.By convenient sampling,154 cases and 103 cases in a certain tertiary hepatobiliary specialized hospital in Shanghai were separately elected to complete the survey.SPSS22.0 was used to test the consistency of the scale,and principal component analysis to verify the reliability and validity of the scales.（2）Quasi-experimental study was adopted in this study,By convenient sampling,90cases in a certain tertiary hepatobiliary specialized hospital in Shanghai were recruited as control group from 1^st Apr to 30^st Jun in 2020.90 cases from 1^st Jul to 31^st Dec in 2020 as intervention group.To verify the effects of the“Platform”by clinical trials in PLC patients with awareness of diagnoses and willingness to participate in treatment decision making;Feasibility outcomes include decision conflict,decision preparation,decision self-efficacy,decision satisfaction and knowledge.Outcomes were measured at the time of treatment decision and/or before they leave.Results1.Construction of a patient decision aids based on m-Health for PLC patients during the decision-making.（1）Qualitative interviews showed that the information needs and preference in SDM of PLC patients include individualized and specialized decision aids process guidance;disease-related somatic symptoms at different stages;introduction of different treatment choices;psychosocial support;self-care at home;popular science of PLC screening,diagnosis,treatment and nursing,besides,most patients want to obtain decision-making information from medical staff in the form of internet and m-Health App.（2）Combined with the results of literature review and qualitative interview,the init-ial decision aids project for PLC patients based on m-Health was constructed.After discussion and revision by expert,the final program was formed,including personal information store;PLC treatment knowledge center;decision aids path;interactive pla-tform and newest information browsing.2.Development of“Treatment Decision Aids Platform”for PLC patients based on We Chat Mini Program.After several rounds of testing and revising by software engineers,researchers and patients,the“Platform”eventually had been developed and contained five main pages::personal information store,PLC treatment knowledge center,decision aids path,health education videos.and background data management system;Five PLC patients and three family members were investigated and interviewed to evaluate the mini wechat programe in terms of system usefulness,information quality and overall evaluation.Researcher and engineer updated the platform for a second time.3.Effectiveness evaluation of the“Treatment Decision Aids Platform”for PLC patients（1）Chinese version of C-DSES Cronbach’s a coefficient is 0.918,KMO value is0.920,factor analysis extracted 1 factors,which could explain 55.157%（>40%）.Chinese version of C-SWDS Cronbach’s a coefficient is 0.838,KMO value is 0.803,factor analysis extracted 1 factors,which could explain55.653%（>40%）.（2）By non parallel controlled clinical trial,“Treatment Decision Aids Platform”can effectively promote PLC patients participate in treatment decisions.The results showed that the preparation for decision,decision self-efficacy,the satisfaction and the know-ledge of the experimental group were significantly higher than the control group（P<0.01）,and the decision conflict was significantly lower than that of control group（P<0.01）.Conclusions1.Constructing the patient decision aids based on m-Health for PLC patients.2.Developing the“Treatment Decision Aids Platform”based on m-Health,which realize the operability,paperless,simple operation and comprehensive content of PDAs,and also has good acceptance and use value.3.The study introduced and chinesized the C-DSES and the C-SWDS with good reliability and validity in PLC patients with awareness of diagnoses and willingness to participate in treatment decision-making.4.the“Treatment Decision Aids Platform”based on the m-Health for PLC patients can effectively promote the realization of the consistency in patients’attitudes and the actual participation in treatment decision making.Furthermore,it can provide convenient decision supports for PLC patients and help them grow into“intelligent patients”,At the same time,it can promote the doctor-patient interaction and accurate communication,really realizing“I Choose My Own Treatment”.