三次谈话模式下中青年乳腺癌手术决策辅助方案的构建与应用

Development and application of a surgical decision-making subplan for the young and middle-aged breast cancer patients based on the three-segmental conversation mode

目的构建中青年乳腺癌手术患者三次谈话模式下的决策辅助方案,并探讨其临床应用价值。方法选择2020年1月至2022年1月拟接受手术治疗的82例中青年乳腺癌患者,按照入组时间分为试验组和对照组,每组41例。对照组给予常规健康教育,试验组在此基础上实施三次谈话模式下的决策辅助方案。2组患者在入院时和手术前1 d,使用决策困境量表(decision conflict scale,DCS)和决策准备量表(preparation for decision making scale,PreDM)进行评估,术后1个月、3个月、6个月,使用决策后悔量表(Decision regret scale,DRS)进行评估。结果手术前1天,试验组DCS量表中信息和价值、决策支持与决策有效性、不确定性等维度得分及总分分别为(12.34±3.99)分、(12.54±4.69)分、(3.68±0.87)分和(28.56±6.93)分,明显低于对照组的(15.39±3.64)分、(18.09±4.15)分、(4.41±1.16)分和(37.90±5.75)分;试验组PreDM量表得分为(73.49±5.21)分,明显高于对照组的(67.98±4.89)分,差异有统计学意义(P<0.05)。术后1个月、3个月、6个月,试验组DRS得分为(29.38±7.47)分、(25.27±2.96)分、(22.70±4.54)分,明显低于对照组的(37.97±6.85)分、(40.89±8.07)分、(38.51±6.57)分,差异有统计学意义(P<0.05)。结论三次谈话模式下的决策辅助方案,可提高中青年乳腺癌患者术前决策准备度,减少决策困境,并能降低患者远期决策后悔度。

Objective To construct a surgical decision-making subplan for the young and middle-aged breast cancer patients based on the three-segmental conversation mode,and to explore its clinical application value.Methods From January 2020 to January 2022,a total of 82 young and middle-aged breast cancer patients who were planned to be surgically treated were assigned to experimental group and control group according to the recruited time,with 41 cases per group.Conventional health care was given to all patients,and the three-segmental conversation mode was additionally given to those of experimental group.On addition and 1 day before the surgery,patients were assessed using the Decision Conflict Scale(DCS)and Preparation for Decision Making Scale(PrepDM).Decision Regret scale(DRS)was surveyed 1,3 and 6 months postoperatively.Results One day before operation,scores of the information and values clarity subscale([12.34±3.99]points vs[15.39±3.64]points),support and effective decision subscale([12.54±4.69]points vs[18.09±4.15]points),and the uncertainty subscale([3.68±0.87]points vs[4.41±1.16]points),and the total DCS scores([28.56±6.93]points vs[37.90±5.75]points)in the experimental group were significantly lower than those in the control group(P<0.05).The PrepDM score in the experimental group was significantly higher than those in the control group([73.49±5.21]points vs 67.98±4.89 points,P<0.05).At 1([29.38±7.47]points vs[37.97±6.85]points),3([25.27±2.96]points vs 40.89±8.07 points)and 6 months postoperatively([22.70±4.54]points vs[38.51±6.57]points),the DRS scores in the experimental group were significantly lower than those in the control group(P<0.05).Conclusion A surgical decision-making subplan based on the three-segmental conversation mode can enhance the preparation for the young and middle-aged breast cancer patients,relief decision conflict,and reduce long-term decision regret.