摘要
目的:开发宫颈癌病人生育力保护及保存问题提示清单并进行测评,为促进病人参与医疗决策提供实用工具。方法:通过文献查阅及质性访谈形成宫颈癌病人问题提示清单初版,之后进行2轮德尔菲专家函询以及预试验形成问题提示清单终版。将2024年1月—3月入院的38例病人作为对照组,2024年6月—8月入院的40例病人作为测评组,测评内容包括问题提示清单反馈问卷、癌症后生育忧虑量表、决策困境量表和决策后悔量表评分;同时选取12名临床医护人员对问题提示清单进行可行性测评。结果:2轮专家函询的权威系数均为0.875,第2轮函询变异系数为0.052~0.140,肯德尔和谐系数为0.401(P<0.001);第2轮函询二级指标重要性评分为3.86~4.93分。最终形成包括背景知识、手术与生育力保护、放化疗与生育、宫颈癌生育力保存方法、费用5个维度的宫颈癌病人生育力保护及保存问题提示清单。测评结果显示,病人对问题清单的反馈呈积极态度,所有病人均表示问题清单很有帮助,80.00%(32/40)的病人表示问题清单将来对我有用;参与测评的12名医护人员均表示问题清单能够帮助更好提问,91.67%(11/12)的医护人员表示问题提示清单对其工作有帮助。病人出院时,对照组决策困境得分为[31.25(29.69,32.81)]分,生育忧虑得分(44.89±3.76)分,治疗后1个月决策后悔得分为[28.00(20.00,36.00)]分;测评组病人决策困境得分为[17.93(15.63,20.31)]分,生育忧虑得分为(36.35±6.72)分,治疗后1个月决策后悔得分为[20.00(20.00,24.00)]分,测评组均低于对照组(P<0.001)。结论:宫颈癌病人生育力保护及保存问题提示清单具有可行性,能够帮助病人更容易提出问题,降低病人决策困境、生育忧虑以及决策后悔水平。
Objective:To develop and evaluate a question prompt list(QPL)for fertility protection and preservation in cervical cancer patients,so as to provide a practical tool to facilitate patient engagement in medical decision-making.Methods:The preliminary QPL was developed through literature review and qualitative interviews,followed by two rounds of Delphi expert consultation and a pilot test to finalize the QPL.A total of 38 patients admitted between January and March 2024 were assigned to the control group,while 40 patients admitted between June and August 2024 were assigned to the intervention group.Assessments included the QPL feedback questionnaire,the Reproductive Concerns After Cancer Scale(RCAC),the Decisional Conflict Scale(DCS),and the Decision Regret Scale(DRS).Additionally,12 healthcare professionals evaluated the feasibility of the QPL.Results:In the two-round Delphi expert consultation,the authority coefficients were both 0.875.The second round showed variation coefficients ranging from 0.052 to 0.140,with a Kendall′s W concordance coefficient of 0.401(P<0.001).The importance scores for secondary indicators in the second round ranged from 3.86 to 4.93.The final fertility protection and preservation QPL for cervical cancer patients was developed,comprising five dimensions:background knowledge,surgery and fertility protection,radiotherapy/chemotherapy and fertility,fertility preservation methods for cervical cancer and cost.Evaluation results demonstrated positive patient feedback on the QPL.All patients reported the QPL as helpful,with 80.00%(32/40)indicating it would be useful for future reference.Among the 12 participating healthcare providers,all affirmed the QPL′s utility in facilitating patient questioning,and 91.67%(11/12)acknowledged its clinical value.At discharge,the control group exhibited significantly higher scores for decision conflict[31.25(29.69,32.81)],fertility-related distress(44.89±3.76),and decision regret[28.00(20.00,36.00)]compared to the intervention group,which scored[17.93(15.63,20.31)],(36.35±6.72),and[20.00(20.00,24.00)]respectively(all P<0.001).Conclusions:The QPL for fertility protection and preservation in cervical cancer patients is feasible.It can help patients pose concerns,reduce decisional conflict,reproductive concerns,and decision regret.
作者
林梦
赵益
卞伶玲
陈旋
吴燕春
谭宇添
叶凡婷
LIN Meng;ZHAO Yi;BIAN Lingling;CHEN Xuan;WU Yanchun;TAN Yutian;YE Fanting(Peking Union Medical College Hospital,Beijing 100730 China)
出处
《护理研究》
北大核心
2025年第17期2859-2867,共9页
Chinese Nursing Research
基金
北京协和医院护理科研项目,编号:XHHLKY202311。
关键词
宫颈癌
生育力保护
生育力保存
问题提示清单
决策困境
生育忧虑
决策后悔
cervical cancer
fertility protection
fertility preservation
question prompt list
decisional conflict
reproductive concerns
decision regret
