| Objective1.A cross-sectional survey was conducted to investigate the current status and influencing factors of patients in laparoscopic surgery in urology on the attitude and actual degree of participation in treatment decision-making.By analyzing the factors influencing patients’ participation in decision-making,we explore the establishment of an effective incentive system to enhance patients’ enthusiasm.2.Based on the Ottawa Decision Support Framework,this paper discusses the application effect of the rapid recovery surgery(ERAS)model under shared decision-making between doctors and patients in the perioperative period of patients with adrenal tumors and renal cysts in urology.3.Through qualitative interviews,the application effect of rapid recovery surgery(ERAS)model under shared decision-making in the perioperative period of urology was further explored,and the driving factors of inpatient participation in treatment decision-making were further explored.It provides a basis for improving patients’ enthusiasm for participating in treatment decisions and improving patients’ medical experience.Methods:Hybrid research methods were used.Part Ⅰ: Analysis of the current status and influencing factors of patients participating in laparoscopic surgery in urologyThe method of convenient sampling was used to facilitate the selection of 192 patients who met the inclusion criteria in the Department of Urology of a tertiary hospital in Kunming from August 2021 to October 2022 as research subjects for current situation investigation and analysis of influencing factors.The general information of patients,the willingness to participate in treatment decision-making/actual questionnaires,and the Control Preferences Scale(CPS)were collected through questionnaire stars and paper questionnaires.SPSS26.0 was used as a statistical analysis tool to perform descriptive statistical analysis,independent sample t-test,Pearson correlation analysis and multiple regression analysis of the obtained data.Part Ⅱ: Construction and initial application of shared decision-making accelerated rehabilitation surgical nursing programGuided by the Ottawa Decision Support Framework,a shared decision-making accelerated rehabilitation surgical treatment program with evidence-based medical evidence was constructed.Based on the results of the first cross-sectional survey,118 patients undergoing laparoscopic surgery with positive attitude towards decision-making participation(< 1.5 points)were included as the study subjects.They were randomly divided into experimental and control groups according to their hospitalization numbers.The control group implemented routine treatment nursing education and rapid recovery nursing,and the experimental group adopted a shared decision-making model that included the intervention content of the control group under the Ottawa decision support framework.SPSS26.0 software is used to perform statistical analysis on the data,and the statistical methods mainly include statistical description,paired sample t-test,independent sample t-test,and chi-square test.The effect of the shared decision-making rapid recovery surgical model was verified by comparing the willingness and actual participation degree,anxiety and depression and treatment decision satisfaction of the two groups to participate in treatment decision-making within and between groups.Part Ⅲ: Participation of Urology Laparoscopic Surgery Patients in a Qualitative Study of Shared Decision Accelerated Rehabilitation SurgeryApply phenomenological research methods to explore the patient’s experience of participating in shared decision-making accelerated rehabilitation surgery.Data are collected by audio and field recording,and Colaizzi qualitative data analysis methods are used to explore and find the transcribed text data to obtain patient participation and shared decision-making accelerated rehabilitation surgical treatment experience.ResultsPart Ⅰ: In this survey,192 questionnaires were distributed and 178 valid questionnaires were returned,with an effective rate of 94.7%.Among the 178 patients surveyed,the overall classification of treatment decision-making participation attitude was mainly passive,81 cases(45.5%);A total of 118 cases(66.29%)had a positive attitude towards treatment decision-making(<1.5 points).A total of 63 cases(35.39%)had high actual participation(<1.5 points).The overall average degree of patient participation in treatment decision-making was(1.59±0.56),and the overall average score of participation attitude was(1.35±0.38).The paired-sample t-test showed that the difference was(0.24±0.42)and P<0.05,which was statistically significant.Attitudes influencing the participation in treatment decisions in patients undergoing laparoscopic urology may be based on gender,age,education,experience with previous medical services,number of other diseases,and disease type.A multivariate logistic regression equation was constructed,and the results showed that the effects of patient age(years),experience of previous medical services,and disease type on patients’ attitude towards treatment decision-making were statistically significant(P<0.05).Possible factors affecting the actual degree of participation in treatment decisions in patients undergoing laparoscopic urology surgery are age,marital status,education level,type of occupation,number of other diseases,and disease type.A multivariate logistic regression equation was constructed,and it was found that the influence of age and education level on the actual degree of patient participation in treatment decision-making was statistically significant(P<0.05).Part Ⅱ: In this study,118 patients were included,and 1 patient in the experimental group changed the surgical method and was excluded;One patient in the control group was transferred to the hospital and excluded.Finally,there were 58 cases in each group in the experimental group and the control group,28 cases of adrenal tumors(posterior laparoscopic adrenal tumor resection),30 cases of renal cysts(laparoscopic renal cyst decompression surgery),25 cases of adrenal tumors(posterior laparoscopic adrenal tumor resection)in the control group,and 33 cases of renal cysts(laparoscopic renal cyst decompression surgery).Compared with the control group,the first time out of bed activity time was significantly improved in the experimental group(adrenal tumors: 9.07±3.11 h vs.13.92±2.63 h,P=0.001;renal cysts 6.47±1.93 h vs.8.79±2.37 h,P=0.001),and the number of postoperative hospital days was significantly shorter than that in the control group(adrenal tumors: 4.29±1.54 d vs.7.24±1.83 d,P=0.001;renal cyst 3.40±1.04 d vs.5.39±1.37 d,P=0.001)。 The postoperative complications in the experimental group were reduced compared with the control group,but the difference was not statistically significant(P>0.05).Compared with the anxiety and depression before and after the intervention of the two groups,there was no significant difference before and after the intervention in the control group(P>0.05),and the total scores of anxiety,depression,anxiety and depression in the experimental group after the intervention of the ERAS program shared decision-making model were lower than before the intervention,and the difference was statistically significant(P<0.05).The satisfaction of decision-making participation in the experimental group was significantly higher than that of the control group(P<0.05).Part Ⅲ: Through the analysis and combing of qualitative research data,four research themes were obtained for patients in laparoscopic surgery in urology to participate in sharing decision-making accelerated rehabilitation surgical experience.1.Psychological trajectory of patients’ decision-making(avoidance,passive acceptance,active search for knowledge)2,willingness to participate in decision-making 3,influencing factors in shared decision-making practice(psychological factors,information factors,communication factors,social support factors)4.Shared decision-making participation experience(ensuring patient-centered positive decision-making experience,treatment experience with high satisfaction,emotional lack in the current epidemic).Conclusions1.Patients undergoing laparoscopic surgery in urology are expected to participate in shared decision-making,but the actual degree of participation is not high.It is mainly affected by age and education level.2.Shared decision-making accelerated rehabilitation surgery is applied to the perioperative care of laparoscopic surgery in urology,which is helpful to promote postoperative rehabilitation,alleviate the anxiety of inpatients and improve patients’ decision-making satisfaction.3.Lack of knowledge,insufficient communication,lack of social support,etc.will adversely affect patients’ participation in treatment decisions.Shared decision-making between caregivers and patients helps patients gain relevant expertise in communication and improve the quality and engagement of patient recovery. |
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