乳腺癌患者手术决策冲突和决策满意度相关因素分析

Factors related to surgical decision conflict and decision satisfaction in breast cancer patients

目的探讨与乳腺癌患者手术决策冲突和决策满意度有关的因素。方法本回顾性研究通过问卷调查的形式收集2018年6月至2018年12月在中山大学孙逸仙纪念医院乳腺肿瘤中心就诊的121例乳腺癌患者的一般资料(包括年龄、婚姻状况、教育程度、子女个数、职业状况、家庭收入、宗教信仰等)、决策冲突和决策满意度情况,采用单因素方差分析和多因素线性回归分析与患者决策冲突和决策满意度有关的因素。结果(1)117例患者有完整的一般资料和决策冲突、决策满意度分数,有效问卷回收率为96.7%(117/121)。117例患者的决策冲突平均为(2.68±2.55)分,满意度分数平均为(4.03±2.73)分;(2)不同特征乳腺癌患者之间决策冲突分数比较,发现婚姻状况与决策冲突分数有关(F=3.778,P=0.013)。多因素分析显示,患者的婚姻状况、宗教信仰状况与其决策冲突分数有关,已婚、离异或丧偶患者的决策冲突分数较未婚者低(B=-2.794,95%CI:-4.837~-0.750,t=-2.709,P=0.008;B=-4.189,95%CI:-6.823~-1.546,t=-3.140,P=0.002),无宗教信仰患者的决策冲突分数低于有宗教信仰患者(B=-1.482,95%CI:-2.776~-0.189,t=-2.271,P=0.025)。(3)不同临床特征乳腺癌患者之间决策满意度比较,发现婚姻状况、家庭月收入与决策满意度分数有关(F=2.736、5.339,P=0.047、0.006)。多因素分析显示,婚姻状况、宗教信仰状况与其决策满意度分数有关,离异或丧偶患者的决策满意度分数低于未婚患者,无宗教信仰患者的决策满意度分数低于有宗教信仰的患者(B=-3.905,95%CI:-6.749~-1.061,t=-2.721,P=0.008;B=-1.793,95%CI:-3.185~-0.401,t=-2.553,P=0.012),未婚患者和有宗教信仰患者的决策满意度更低。结论未婚和有宗教信仰的患者更容易出现决策冲突和更低的决策满意度。在临床工作中应该重点关注这部分患者并对其进行辅助决策,从而减少其决策冲突,增加决策满意度。

Objective To explore the factors related to surgical decision conflict and decision satisfaction of breast cancer patients.Methods This retrospective study enrolled 121 patients with breast cancer in the Breast Tumor Center of Sun Yat-sen Memorial Hospital,Sun Yat-sen University from June to December 2018 and analyzed their general data(including age,marital status,education,number of children,occupational status,family income and religious belief),decision conflict and decision satisfaction.The analysis of variance and linear regression were used to analyze the factors concerning to decision conflict and decision satisfaction.Results(1)Totally 117 patients had complete general information,decision conflict,and decision satisfaction scores.The recovery rate of valid questionnaires was 96.7%(117/121).The decision conflict score of 117 patients was 2.68±2.55,and the satisfaction score was 4.03±2.73.(2)The comparison of decision conflict scores among breast cancer patients with different characteristics showed that marital status was related to decision conflict scores(F=3.778,P=0.013).Multivariate analysis showed that patients’marital status and religious belief were related to their decision conflict scores.Married,divorced or widowed patients had a significantly lower decision conflict score compared with unmarried patients(B=-2.794,95%CI:-4.837--0.750,t=-2.709,P=0.008;B=-4.189,95%CI:-6.823--1.546,t=-3.140,P=0.002).The decision conflict score of patients without religious belief was significantly lower than that of patients with religious belief(B=-1.482,95%CI:-2.776--0.189,t=-2.271,P=0.025).(3)The comparison of decision satisfaction among breast cancer patients with different clinical characteristics showed that marital status and family income were related to decision satisfaction scores(F=2.736,5.339,P=0.047,0.006).Multivariate analysis shows that marital status and religious belief status were related to decision satisfaction scores.Divorced or widowed patients had a significantly lower decision satisfaction score compared with unmarried patients,and the patients without religious belief had a significantly lower decision satisfaction score compared with those with religious belief(B=-3.905,95%CI:-6.749--1.061,t=-2.721,P=0.008;B=-1.793,95%CI:-3.185--0.401,t=-2.553,P=0.012).Conclusions Unmarried patients and patients with religious belief are more likely to have decision conflict and lower decision satisfaction.In clinical practice,we should pay more attention to these patients and give decision aids,so as to reduce decision conflict and increase decision satisfaction.