Abstract:

Objective To explore the facilitating factors and obstacles of medical care in the implementation of breast cancer patient-centered decision-making assistance,and to provide references for further clinical decision-making assistance on a large scale. Methods The semi-structured interview method, convenience sampling and purpose sampling were adopted. 13 nurses and 7 doctors who worked in a breast oncology department of a tertiary A hospital in Tianjin from May to November 2020 were selected to conduct semi-structured interviews. The analysis method was used to organize and analyze the data and to describe the theme. Results The facilitating factors and obstacles to assisting decision-making nurses to implement assistant decision-making experience are extracted. The 3 sub-themes of the facilitating factor theme include awareness of the importance of decision-making assistance,the patient’s decision-making assistance needs,the trust between patients and medical staff. The 5 sub-themes of the obstacles theme include environmental constraints,lack of confidence in medical staff,information asymmetry,insufficient patient participation in decision-making,and imperfect decision-making assistance systems. Conclusion There are certain obstacles and facilitating factors in the implementation of breast cancer patient-centered decision-making assistance for medical staff. They should actively face the challenges in the implementation of decision-making assistance,get aware of the importance of doctors,nurses,and patients in the decision-making process,and improve auxiliary tools and work processes of the decision-making,so as to build a decision-making assistance model that conforms to China’s national conditions.

Key words: Breast Neoplasms, Decision-Making Assistance, Medical Personnel, Qualitative Study, Nursing Care

摘要：

目的 了解医护人员在实施以乳腺癌患者为中心决策辅助过程中的促进因素与障碍因素,为进一步临床大范围实施决策辅助提供参考。方法 采用目的抽样的方法,选取2020年5月—11月在天津市某三级甲等医院乳腺肿瘤科工作的13名护士及7名医生进行半结构式访谈,运用内容分析法对资料进行整理分析,进行主题描述。结果 提炼出医护人员实施辅助决策的促进因素及障碍因素,促进因素主题的3个亚主题包括意识到决策辅助的重要性、患者的决策辅助需求、患者与医护人员的信任,障碍因素主题的5个亚主题包括环境限制、医护人员信心不足、信息不对称、患者决策参与不足、决策辅助体系不完善。结论 医护人员在实施乳腺癌患者决策辅助过程中存在着一定的障碍及促进因素,应正视医生、护士、乳腺癌患者参与决策的重要性,完善决策辅助工具及工作流程,构建符合我国国情的决策辅助模式。

关键词: 乳腺肿瘤, 决策辅助, 医护人员, 质性研究, 护理