由于乳腺癌手术治疗的多样化和高敏感性,各种决策风格在权衡和共享信息方面表现出不同的功能。共同决策是促进健康结果的最佳实践范式。本研究旨在确定共享决策的总体频率,并从乳腺癌患者的角度探讨手术决策过程中的影响因素。我们在8个数据库中搜索了关于乳腺癌患者手术决策控制偏好和共同决策偏好的研究。两名研究人员筛选了文献,提取数据,并对文献质量进行了评价。对偏好和实际共享决策的频率以及决策一致性进行了荟萃分析。由于对影响因素的研究有限,采用描述性分析。本研究包括14项原始研究。我们发现,首选共享决策的总体合并频率为48.1%(95CI33.5%,62.6%)和实际共享决策38.1%(95CI33.9%,42.2%)。此外,偏好决策风格和实际决策风格之间决策一致性的合并频率为61.7%(95CI54.6%,68.8%)。描述性分析结果表明,共享决策的影响因素包括个体因素,外科医生-患者沟通因素,和健康环境因素。在手术背景下,首选决策风格和实际决策风格之间存在差距。因此,医疗保健提供者应确定潜在的共同决策障碍和促进者,并倡导临床共享决策模型,将共享决策嵌入日常实践中。
Due to the diversified and high sensitivity of breast cancer surgical treatment, various decision making styles show different functions in making trade-offs and sharing information. Shared decision making is the best practice paradigm to promote health outcomes. This study aimed to determine the overall frequency of shared decision making and explore influencing factors during the surgical decision-making process from breast cancer patients\' perspectives. We searched 8 databases for studies about breast cancer patients\' surgical decisional control preferences and shared decision making preference. Two researchers screened the literature, extracted the data, and evaluated the literature quality. Meta-analysis of the frequency of preferred and actual shared decision making and decision congruence was performed. Due to the limited studies of influencing factors, descriptive analysis was used. Fourteen original studies were included in this study. We found the overall pooled frequency of the preferred shared decision making of 48.1% (95%CI 33.5%, 62.6%) and the actual shared decision making of 38.1% (95%CI 33.9%, 42.2%). Moreover, the pooled frequency of the decision congruence between preferred and actual decision styles was 61.7% (95%CI 54.6%, 68.8%). The descriptive analysis findings indicated that the influencing factors of shared decision making included individual factors, surgeon-patient communication factors, and health setting factors. There was a gap between the preferred and actual decision styles in the surgical context. Therefore, health care providers should identify potential shared decision making barriers and facilitators, and advocate the clinical shared decision making model to embed shared decision making into routine practice.