原发性肝癌诊断知情患者参与手术决策现状及影响因素研究

摘要

Objective To investigate the current status of participation in surgery decision-making of informed primary liver cancer patients and to explore its influence factors. Methods With convenient sampling, 145 informed primary liver cancer patients receiving surgical treatment were recruited from a Class Ⅲ Grade Ⅰhepatobiliary specialized hospital and investigated with participation in surgery decision-making questionnaire developed on the basis of the Control Preference Scale (CPS). Spearmen correlation analysis and multivariate logistic regression were used to analyze its influencing factors. Results Totally, 41.4%of the patients considered their surgery decisions were determined by surgeons and 36.5% by family members and the rate of surgery decision-making by surgeons and family members was greater than patients ’ expected rate. For 55.9% of the family members, their participation in surgery decision-making coincided with their expectation while 35.9% of them considered the actual participation rate was greater than their expected rate. Age, education background, average monthly income of family and whether the first surgery or not were influence factors (P<0.05). Younger patients, higher education, more average monthly income of family and not the first surgery patients actually involved in higher decision-making procedure. Conclusion Primary liver cancer patients participate in surgery decision-making passively. Family members play an important role in surgical decision-making, but their actual participation rate is greater than patients’ expected rate. More communication with the patients and family members to meet patients ’ demands of knowledge related to treatment is needed and the model of shared decision-making by surgeons, patients and their family members should be propelled.%目的：了解原发性肝癌诊断知情患者参与手术决策现状及影响因素。方法以决策期待量表（Control Preference Scale, CPS）为基础设计患者参与手术决策调查问卷，采用方便抽样法，对某三级甲等肝胆专科医院145例诊断知情的原发性肝癌术后患者进行问卷调查,并采用Spearmen相关分析及多元有序Logistic回归分析其影响因素。结果原发性肝癌诊断知情患者期望参与手术决策方式与实际参与方式的符合率57.2%；36.5%患者实际参与手术决策方式为家属全权代理型，41.4%为由医生决策的被动型，患者两种被动参与手术决策的实际大于其期望。患者期望家属参与手术决策程度与家属实际参与程度符合率55.9%，35.9%患者认为家属实际参与程度多于其期望。患者年龄、文化程度、人均月收入和是否首次手术等是患者实际参与方式的独立影响因素（P<0.05）。年轻、文化程度高、家庭人均月收入高和非首次手术患者实际参与手术决策较高。结论原发性肝癌诊断知情患者在手术决策中处于被动地位，参与手术决策实际小于其期望；家属是患者手术决策的重要参与者，但家属实际参与程度超过患者期望其参与的程度。医护人员应评估患者决策需求，加强与患者及家属沟通，可率先在年龄较轻、文化程度较高且有参与决策意愿的患者中推进医生-患者-家属三方共享决策，保障其决策参与权与选择权。