PDF(Pubmed)
Abstract：
BACKGROUND: Due to the diversity and high sensitivity of the treatment, there were difficulties and uncertainties in the breast cancer surgical decision-making process. We aimed to describe the patient\'s decision-making behaviour and shared decision-making (SDM)-related barriers and facilitators in breast cancer surgical treatment.
METHODS: We searched eight databases for qualitative studies and mixed-method studies about breast cancer patients\' surgical decision-making process from inception to March 2021. The quality of the studies was critically appraised by two researchers independently. We used a \'best fit framework approach\' to analyze and synthesize the evidence.
RESULTS: Twenty-eight qualitative studies and three mixed-method studies were included in this study. Four themes and 10 subthemes were extracted: (a) struggling with various considerations, (b) actual decision-making behaviours, (c) SDM not routinely implemented and (d) multiple facilitators and barriers to SDM.
CONCLUSIONS: Patients had various considerations of breast surgery and SDM was not routinely implemented. There was a discrepancy between information exchange behaviours, value clarification, decision support utilization and SDM due to cognitive and behavioural biases. When individuals made surgical decisions, their behaviours were affected by individual-level and system-level factors. Therefore, healthcare providers and other stakeholders should constantly improve communication skills and collaboration, and emphasize the importance of decision support, so as to embed SDM into routine practice.
UNASSIGNED: This systematic review was conducted as part of a wider research entitled: Breast cancer patients\' actual participation roles in surgical decision making: a mixed method research. The results of this project helped us to better analyze and generalize patients\' views.
METHODS: We searched eight databases for qualitative studies and mixed-method studies about breast cancer patients\' surgical decision-making process from inception to March 2021. The quality of the studies was critically appraised by two researchers independently. We used a \'best fit framework approach\' to analyze and synthesize the evidence.
RESULTS: Twenty-eight qualitative studies and three mixed-method studies were included in this study. Four themes and 10 subthemes were extracted: (a) struggling with various considerations, (b) actual decision-making behaviours, (c) SDM not routinely implemented and (d) multiple facilitators and barriers to SDM.
CONCLUSIONS: Patients had various considerations of breast surgery and SDM was not routinely implemented. There was a discrepancy between information exchange behaviours, value clarification, decision support utilization and SDM due to cognitive and behavioural biases. When individuals made surgical decisions, their behaviours were affected by individual-level and system-level factors. Therefore, healthcare providers and other stakeholders should constantly improve communication skills and collaboration, and emphasize the importance of decision support, so as to embed SDM into routine practice.
UNASSIGNED: This systematic review was conducted as part of a wider research entitled: Breast cancer patients\' actual participation roles in surgical decision making: a mixed method research. The results of this project helped us to better analyze and generalize patients\' views.
摘要：
背景：由于治疗的多样性和高灵敏度，乳腺癌手术决策过程存在困难和不确定性.我们旨在描述患者在乳腺癌手术治疗中的决策行为和共同决策（SDM）相关障碍和促进因素。
方法：我们检索了8个数据库，以获取有关乳腺癌患者手术决策过程的定性研究和混合方法研究。研究的质量由两名研究人员独立进行了严格评估。我们使用了“最佳框架方法”来分析和综合证据。
结果：本研究包括28项定性研究和3项混合方法研究。提取了四个主题和10个子主题：（a）与各种考虑因素作斗争，(b)实际决策行为，(c)没有例行实施的可持续发展管理和(d)可持续发展管理的多重促进者和障碍。
结论：患者对乳房手术有各种考虑，未常规实施SDM。信息交换行为之间存在差异，价值澄清，认知和行为偏差导致的决策支持利用和SDM。当个人做出手术决定时，他们的行为受到个体水平和系统水平因素的影响。因此,医疗保健提供者和其他利益相关者应不断提高沟通技巧和协作，并强调决策支持的重要性，以便将SDM嵌入到日常实践中。
■这项系统评价是作为一项更广泛的研究的一部分进行的：乳腺癌患者在手术决策中的实际参与作用：一项混合方法研究。该项目的结果帮助我们更好地分析和概括患者的观点。
方法：我们检索了8个数据库，以获取有关乳腺癌患者手术决策过程的定性研究和混合方法研究。研究的质量由两名研究人员独立进行了严格评估。我们使用了“最佳框架方法”来分析和综合证据。
结果：本研究包括28项定性研究和3项混合方法研究。提取了四个主题和10个子主题：（a）与各种考虑因素作斗争，(b)实际决策行为，(c)没有例行实施的可持续发展管理和(d)可持续发展管理的多重促进者和障碍。
结论：患者对乳房手术有各种考虑，未常规实施SDM。信息交换行为之间存在差异，价值澄清，认知和行为偏差导致的决策支持利用和SDM。当个人做出手术决定时，他们的行为受到个体水平和系统水平因素的影响。因此,医疗保健提供者和其他利益相关者应不断提高沟通技巧和协作，并强调决策支持的重要性，以便将SDM嵌入到日常实践中。
■这项系统评价是作为一项更广泛的研究的一部分进行的：乳腺癌患者在手术决策中的实际参与作用：一项混合方法研究。该项目的结果帮助我们更好地分析和概括患者的观点。
