乳腺癌患者治疗决策参与体验的系统评价

Participation Experience in Treatment Decision Making for Breast Cancer Patients: A Systematic Review

目的:系统评价乳腺癌患者在治疗决策参与过程中的体验。方法:通过计算机系统检索PubMed、Web of Science、Embase、Cochrane Library、PsycINFO以及中国知网、万方、维普、中国生物医学文献数据库从建库至2020年5月,关于乳腺癌患者治疗决策参与体验主题的质性研究。采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准评价纳入研究的文献质量,采用汇集性整合法进行结果整合。结果:共纳入18篇文献,提炼出73个结果,归纳出17个类别,得到6个整合结果。① 对诊断反应:情绪反应;② 决策与治疗偏好:决策偏好、治疗偏好;③ 治疗方式的影响因素:感知风险与益处、家庭因素、社会环境因素;④ 决策结局:决策质量、治疗结局;⑤ 决策困境:信息不匹配、决策时间压力、决策后果责任、医生相关障碍因素、情绪困扰、经济负担;⑥ 决策资源:患者准备、社会支持、医生相关促进因素。结论:乳腺癌患者的治疗决策参与是一个多层次、多阶段的决策实践过程。患者在不同阶段具有不同的决策体验。医护人员应及时识别患者参与治疗决策的困境和需求,有效利用决策资源,促进患者参与治疗决策,最终做出符合患者价值观的治疗决策。

Objective: To systematically review the experience of breast cancer patients in treatment deci-sion-making participation. Methods: We searched database including PubMed, Web of Science, Embase, Cochrane Library, PsycINFO, CNKI, WANFANG, VIP, CBM from inception to May 2020. The JBI Critical Appraisal Tool for qualitative research was used to evaluate the quality of studies. The results were integrated by using integrating methods. Results: A total of 18 studies were included, 73 results were extracted, 17 categories were summarized and 6 integrated results were obtained. 1) Diagnosis of reaction: emotional response;2) Decision-making and treatment preferences: decision-making preferences, treatment preferences;3) Determinants of treatment: perceived risks and benefits, family factors, social environmental factors;4) Decision outcome: decision quality, treatment outcomes;5) Decision conflict: information mismatch, decision time pressure, responsibility for consequences of decision, physician-related barriers, emotional distress, economic burden;6) Decision support: patient preparation, social support, physician-related facilitators. Conclusion: Participation in the treatment decision-making of breast cancer patients is a multilevel and multistage process. Patients have different decision-making experiences at different stages. Health care workers should timely identify the difficulties and needs of patients to participate in treatment decision, and effectively use decision-making resources to make treatment decisions consistent with patient’s values.