Analysis Of Current Situation And Influencing Factors Of Participation Of Patients With Lung Cancer In Shared Decision-making

Objective To study the current situation of participation of patients with lung cancer in clinical treatment and nursing sharing decision-making,and to analyze the factors of participation of patients with lung cancer in clinical decision-making from 4 aspects: physicians,nurses,patients and relatives.Methods In this study,a cross-sectional survey was conducted by using the method of random sampling.A total of 533 patients with lung cancer were selected from the Department of Thoracic Surgery and Oncology in a third-class hospital in Qingdao from September 1st,2018 to December 30 th,2019.According to the results of histopathology and the principle of informed consent,300 patients with lung cancer who fully met the requirements were screened.The basic data questionnaire,decision expectation scale and participation of patients with lung cancer in treatment and nursing decision scale were distributed.After the same questionnaire was given to guide the language training,the pre-answer to the final answer was completed through the Wenjuanxing.After the data were collected,the data were entered into SPSS 20.0 for processing and further analysis.The statistical methods included descriptive statistical analysis,chi-square test,paired sample rank sum testand Logistic regression analysis.The current situation of participation of patients with lung cancer in sharing decision-making and related factors were obtained.According to the theory of Ottawa decision support framework,semi-structured interviews were conducted from 4aspects(physicians,nurses,patients and relatives),and the interview outline,pre-interview,formal interview was conducted according to the order of the interview.The interview content was sorted out according to the saturation of information,and the factors affecting participation of patients with lung cancer in sharing decision-making were further identified.Results1 According to the results of the decision expectation scale,in the process of clinical treatment decision-making,the expected and actual shared types of patients with lung cancer were 39.00% and 11.33% respectively,with the coincidence rate of 53.67%.There was a statistical difference between expectation and actual classification(P < 0.01).The actual sharing rates between patients with lung cancer and their relatives were 66.33% and 40.67%respectively,with the coincidence rate of 42.00%.And a consistency coefficient K value of0.40.There was a statistical difference between expectation and actual classification(P <0.01).2 According to the results of the scale of participation of patients with lung cancer in treatment and nursing decision-making,61.33% of patients with lung cancer have a positive attitude towards treatment of sharing decision-making,and 27.33% of patients actually have a high degree of participation(Z value ranged from-10.56 to 6.28,P < 0.01).The actual degree of participation in treatment decision-making was lower than that of participation attitude,which was mainly related to gender,age,education,method of payment,average income of their relatives,living environment,number of children,course of disease,TNM stage and so on.The participation attitude and actual participation degree of patients with lung cancer to nursing sharing decision-making were low,but the participation degree of nursing sharing decision-making was lower than that of participation attitude(Z value ranged from-8.85 to-3.43,P < 0.01),which was mainly related to gender,education,average income of their relatives,personality,course of disease,TNM stage and so on.3 Based on the in-depth analysis and arrangement of the interview data,four topics were summarized:(1)relatives are the main decision-makers for lung cancer patients in sharing;(2)attitudes towards lung cancer patients’ participation in Shared decision making;(3)the necessity of participation of sharing decision-making;(4)pressure on lung cancer patients to participate in Shared decision making.There were three perspective for futher discussed: individuals,medical institutions,society and laws policies.Conclusion1 The expectation and reality of participation of patients with lung cancer in treatment decision-making are mainly passive,and the expectation of participation of patients is not consistent with the actual participation of relatives,doctors and nurses.2 Education level,the average of family income,course stage and TNM stage were the main factors affecting the attitude and actual degree of participation in the Shared decision-making of lung cancer.Gender and age affect the actual degree of patients’ participation in treatment and nursing decision-making.Personality and number of children affect the degree of patients’ participation in nursing decision-making.3 Participation of patient in shared decision-making is a healthy development trend in the global health care field,which is consistent with the top ten patient safety goals in 2019 to encourage patients and their relatives to participate in patient safety.Family members and medical staff should correctly assess the patient’s own conditions,distinguish whether they can participate in the shared decision-making and encourage patients to participation the target,established a correct understanding,to create a harmonious and safe medical environment.