乳腺癌术后乳房重建患者决策辅助工具的构建及效果评价

 目的 构建乳腺癌重建患者决策辅助工具，并评价其临床应用效果。方法 在渥太华决策支持理论框架指导下，通过文献分析法形成国内首个乳腺癌重建患者决策辅助草案，通过专家会议法，初步修订决策辅助内容，再通过半结构式访谈利益相关人员，形成决策辅助工具最终版。根据纳入标准，选取2019年5—8月接受乳腺癌术后乳房重建手术的52例患者作为对照组，选取2019年9—12月接受乳腺癌术后乳房重建手术的54例患者作为干预组。对照组采用常规护理，干预组在常规护理的基础上使用决策辅助工具。两组患者在术前分别使用决策冲突量表，Breast-Q术前模块和期望模块进行基线调查，并在术后一个月进行决策冲突量表和决策后悔量表调查，在术后的3个月进行决策冲突量表、决策后悔量表和Breast-Q术后模块调查。结果 对照组和干预组中94.5%的乳腺癌患者希望得到更多的乳房重建信息，80.8%的患者希望能够一定程度地参与到乳房重建决策中。干预组和对照组在决策冲突的比较中存在显著的时间效应、分组效应和交互效应（P<0.05）。干预组和对照组的决策后悔得分在术后1个月时差异无统计学意义，但在术后3个月时存在显著差异（P<0.05），干预组的决策后悔得分显著低于对照组（P<0.05）。两组Breast-Q术后医护人员满意度模块存在显著差异（P<0.05），干预组对外科医师及其他工作人员的满意度显著高于对照组。结论 本研究构建的决策辅助工具有科学性、可靠性和可行性，乳腺癌患者对重建期望值较高，同时也希望能够参与到重建决策中；决策辅助工具的临床应用能够减少患者的重建决策冲突和远期决策遗憾，提高患者对医护人员的满意度。

Construction and effect evaluation of decision support tool for breast reconstruction of patients with breast cancer after operation

Objective To construct a decision support tool for breast reconstruction of patients with breast cancer after operation, and to evaluate its effect in clinical application. Methods Under the guidance of the Ottawa decision support theory framework, the first Chinese version of decision-making assistance for breast cancer reconstruction patients was formed through literature analysis, then relevant experts were consulted through the expert meeting method, the decision-making assistance content was initially revised, and then the decision-making assistance was formed through semi-structured interviews with stakeholders. According to the inclusion criteria, 52 patients who underwent breast cancer reconstruction surgery from May to Aug 2019 were selected as the control group, and 54 patients who underwent breast cancer reconstruction surgery from Sep to Dec 2019 were selected as the intervention group. The control group received routine nursing, and the intervention group was supported with decision-making aids on the basis of routine nursing. Patients of the two groups were investigated with decision conflict scale, Breast-Q pre-operative module and expectation module before operation, decision conflict scale and decision regret scale one month after operation, and decision conflict scale, decision regret scale and Breast-Q post-operative module three months after operation. Results In the two groups, 94.5% of the breast cancer patients hoped to get more breast reconstruction information, and 80.8% of the patients hoped to be able to participate in breast reconstruction decision-making to a certain extent. Both groups showed significant time effect, group effect and interaction effect (P<0.05) on conflicts in decision-making. The decision regret scores of the two groups were not significantly different 1 month after surgery, but were significantly different 3 months after surgery (P<0.05), and the decision regret score of the intervention group was significantly lower than that of the control group (P<0.05). There was a significant difference in the satisfaction module of medical staff after Breast-Q (P<0.05), and the satisfaction of surgeons, surgeons and other staff in the intervention group was significantly higher than that of the control group. Conclusion The decision-making aids constructed in this study are scientific, reliable and feasible. Breast cancer patients have high expectations of reconstruction, and also hope to participate in reconstruction decision-making. The clinical application of decision-making aids can reduce the conflict of reconstruction decision-making and long-term decision-making regret of patients, and improve the satisfaction of patients to medical staff.