乳腺癌乳房再造手术患者决策辅助方案的构建及应用

doi:10.3761/j.issn.0254-1769.2020.01.015

摘要/Abstract

摘要：

目的探讨决策辅助方案在拟行乳腺癌全乳切除术联合乳房再造术患者中的应用效果。方法通过参考国内外文献、召开专家会议及研究小组讨论,构建乳腺癌乳房再造手术患者决策辅助方案（以下简称患者决策辅助方案）。选取2017年10月—12月住院行手术治疗的乳腺癌患者为对照组（42例）,2018年1月—3月住院行手术治疗的乳腺癌患者为试验组（39例）。试验组在常规健康教育的基础上实施决策辅助方案,对照组给予常规健康教育。两组患者入院日、手术前1 d,分别使用患者决策困境量表、决策准备量表、医院焦虑抑郁量表进行评估;术后1个月、6个月和12个月,分别使用患者决策后悔量表、医院焦虑抑郁量表进行评估。结果试验组术前1 d的决策准备得分显著高于对照组（P<0.05）,决策困境得分显著低于对照组（P<0.05）;术前1 d试验组焦虑抑郁得分与对照组差异无统计学意义（P>0.05）;术后12个月试验组焦虑抑郁得分均显著低于对照组（P<0.05）;术后随访期间,试验组在术后1个月、6个月和12个月的决策后悔得分均显著低于对照组（P<0.05）。结论本研究制订的患者决策辅助方案,可提高患者术前决策准备度,降低患者决策困境水平,改善患者远期的焦虑抑郁情绪,降低患者远期的决策后悔度。

关键词: 乳腺肿瘤, 乳房成形术, 决策, 外科手术, 决策支持系统,临床

Abstract:

Objective To investigate the effects of application of decision aid of breast reconstruction in breast cancer patients after mastectomy. Methods We developed the breast reconstruction decision aid for breast cancer patients based on the literatures at home and abroad,expert meeting and group discussion. A total of 42 patients hospitalized for breast cancer surgery from October to December,2017,were recruited as the control group,and 39 patients admitted from January to March,2018,were enrolled as the intervention group. In addition to routine nursing,the intervention group received the breast reconstruction surgery decision aid,while the control group only received routine nursing. The results of intervention were evaluated by Decision Conflict Scale（DCS）,Preparation Decision Making （PrepDM） and Hospital Anxiety and Depression Scale （HADS） at admission and one day before operation;Decision Regret scale（DRS） and HADS were used at one month,six months and one year after operation. Results The decision preparation score one day before operation in the intervention group was significantly higher than that of the control group（P<0.05）,and the decision conflict score of the intervention group was significantly lower（P<0.05）. There was no significant difference in the anxiety and depression scores between the intervention group and the control group one day before surgery. Anxiety and depression scores in the intervention group were significantly lower than those in the control group one year after surgery（P<0.05）. During postoperative follow-up,the decision regret scores of the intervention group were significantly lower than those of the control group at one month,six months and one year after surgery（P<0.05）. Conclusion The breast reconstruction surgery decision aid can effectively improve patients’ decision preparation,alleviate long-term anxiety and depression,and reduce long-term decision regret.

Key words: Breast Neoplasms, Mammaplasty, Decision Making, Surgical Procedures, Operative, Decision Support Systems, Clinical

王燕, 王小媛, 石立元, 李静, 张青月, 殷竹鸣, 强万敏. 乳腺癌乳房再造手术患者决策辅助方案的构建及应用[J]. 中华护理杂志, 2020, 55(1): 90-95.

WANG Yan, WANG Xiaoyuan, SHI Liyuan, Li Jing, ZHANG Qingyue, YIN Zhuming, QIANG Wanmin. Development and application of decision aid of breast reconstruction surgery among breast cancer patients[J]. Chinese Journal of Nursing, 2020, 55(1): 90-95.

图/表 5

表1 两组一般资料的比较[例（百分比,%）]

表2 两组干预前后决策困境与决策准备度得分比较（分,$\bar{x}$±s）

表3 两组干预前后焦虑和抑郁水平得分比较（分,$\bar{x}$±s）

表4 两组随访期间焦虑和抑郁水平得分比较（$\bar{x}$±s）

表5 两组随访期间决策后悔水平得分比较（$\bar{x}$±s）

参考文献 34

[1]	Bray F, Ferlay J, Soerjomataram I , et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018,68(6):394-424.
[2]	Wu CC, Li MN, Meng HB , et al. Analysis of status and countermeasures of cancer incidence and mortality in China[J]. Sci China Life Sci, 2019,62(5):640-647.
[3]	Siegel RL, Miller KD, Jemal A . Cancer statistics,2017[J]. CA:Cancer J Clin, 2017,67(1):7-30.
[4]	Zhou KN, Wang DL, He XL , et al. Effectiveness of a multimo-dal standard nursing program on health-related quality of life in Chinese mainland female patients with breast cancer:protocol for a single-blind cluster randomized controlled trial[J]. BMC Cancer, 2016,16:698.
[5]	Panchal H, Matros E . Current trends in postmastectomy breast reconstruction[J]. Plast Reconstr Surg, 2017,140(5S Advances in Breast Reconstruction):7S-13S.
[6]	Schmauss D, Machens HG, Harder Y . Breast reconstruction after mastectomy[J]. Front Surg, 2015,2:71.
[7]	Holtzmann J, Timm H . The experiences of and the nursing care for breast cancer patients undergoing immediate breast reconstruction[J]. Eur J Cancer Care (Engl), 2005, 14(4):310-318.
[8]	Stacey D, Légaré F, Lewis K , et al. Decision aids for people facing health treatment or screening decisions[J]. Cochrane Data-base Syst Rev, 2017, 4:CD001431.
[9]	Nicholas Zdenkowski, Butow P, Tesson S , et al. A systematic review of decision aids for patients making a decision about treatment for early breast cancer[J]. Breast, 2016,26:31-45.
[10]	廖宗峰, 方汉萍, 刘洪娟 . 病人决策辅助的研究现状和进展[J]. 护理研究, 2014,28(35):4360-4363.
[11]	王燕, 张青月 . 乳房再造患者术前决策体验的质性研究[J]. 天津护理, 2019,27(2):131-134.
[12]	Lloyd A, Joseph-Williams N, Edwards A , et al. Patchy ‘coherence’:using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC)[J]. Implement Sci, 2013,8:102.
[13]	Légaré F, O’Connor AC, Graham I, , et al. Supporting patients facing difficult health care decisions:use of the Ottawa decision support framework[J]. Can Fam Physician, 2006,52:476-477.
[14]	中国抗癌协会乳腺癌专业委员会CBCS, 中国医师协会外科医师分会乳腺外科医师专委会CSBS. 乳腺肿瘤整形与乳房重建专家共识(2018年版)[J]. 中国癌症杂志, 2018,28(6):439-480.
[15]	Shepherd HL, Barratt A, Trevena LJ , et al. Three questions that patients can ask to improve the quality of information physicians give about treatment options:a cross-over trial[J]. Patient Educ Couns, 2011,84(3):379-385.
[16]	O’Connor AM . Validation of a decisional conflict scale[J]. Med Decis Making, 1995,15(1):25-30.
[17]	Lam WW, Kwok M, Liao QY , et al. Psychometric assessment of the Chinese version of the decisional conflict scale in Chinese women making decision for breast cancer surgery[J]. Health Expect, 2015,18(2):210-220.
[18]	Bennett C, Graham ID, Kristjansson E , et al. Validation of a preparation for decision making scale[J]. Patient Educ Couns, 2010,78(1):130-133.
[19]	李玉 . 早期原发性肝癌患者治疗决策辅助方案的构建与应用研究[D]. 上海:第二军医大学, 2017.
[20]	Connors LM, Voian N, Shi Y , et al. Decision making after BRCA genetic testing. Down the road of transition[J]. Clin J Oncol Nurs, 2014,18(3):E58-E63.
[21]	陈芳, 程晓姣 . 中文版决策后悔量表应用于面部美容受术者的信效度评价[J]. 护理学报, 2018,25(7):42-44.
[22]	康晓凤, 李峥, 刘华平 . 基于和谐护理理论的患者参与决策情境分析[J]. 中华护理杂志, 2018,53(4):498-501.
[23]	柏冬丽, 侯晓婷, 刘晓红 , 等. 肿瘤晚期患者参与临床决策期望的现况研究[J]. 护理学杂志, 2017,32(5):35-38.
[24]	侯晓婷, 徐征, 周玉洁 , 等. 结直肠癌住院患者参与手术治疗决策的现况研究[J]. 中华护理杂志, 2014,49(5):526-529.
[25]	刘晓娜, 潘红英 . 护理决策支持系统的应用进展[J]. 中华护理杂志, 2018,53(6):735-739.
[26]	罗惠文, 陈丹妮, 徐霞 , 等. 三级医院门诊病人参与决策满意度及其影响因素分析[J]. 中国医院管理, 2018,38(7):20-22.
[27]	Bourmaud A, Soler-Michel P, Oriol M , et al. Decision aid on breast cancer screening reduces attendance rate:results of a large-scale,randomized,controlled study by the DECIDEO group[J]. Oncotarget, 2016,7(11):12885-12892.
[28]	van Tol-Geerdink JJ, Leer JW, Wijburg CJ , et al. Does a decision aid for prostate cancer affect different aspects of decisional regret,assessed with new regret scales? A randomized,controlled trial[J]. Health Expect, 2016,19(2):459-470.
[29]	Lam WW, Chan M, Or A , et al. Reducing treatment decision conflict difficulties in breast cancer surgery:a randomized controlled trial[J]. J Clin Oncol, 2013,31(23):2879-2885.
[30]	薛翠翠, 刘均娥 . 乳腺癌患者体像及心理干预的研究进展[J]. 中华护理杂志, 2015,50(6):728-732.
[31]	Temple-Oberle CF, Ayeni O, Cook EF , et al. The breast reconstruction satisfaction questionnaire (BRECON-31):an affirmative analysis[J]. J Surg Oncol, 2013,107(5):451-455.
[32]	Temple-Oberle CF, Cook EF, Bettger-Hahn M , et al. Development of a breast reconstruction satisfaction questionnaire (BRECON-31):principal components analysis and clinimetric properties[J]. J Surg Oncol, 2012,106(7):799-806.
[33]	王露, 陈英, 崔金锐 , 等. 直肠癌术式患者决策辅助方案的制订及应用研究[J]. 中华护理杂志, 2019,54(3):338-343.
[34]	Yi M, Joung WJ, Park EY , et al. Decision making experience on breast reconstruction for women with breast cancer[J]. J Ko-rean Acad Nurs, 2016,46(6):894-904.