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Factors influencing patient decision-making between simple mastectomy and surgical alternatives.

ABSTRACT: Background:Despite similar survival rates, breast-conserving therapy (BCT) remains a distant second choice after simple mastectomy for patients with early-stage breast cancer in Singapore. Uptake of reconstruction after mastectomy is also low (18 per cent). The aim of this study was to explore the factors influencing a patient's choice for mastectomy when eligible for BCT, and why patients decline reconstruction after mastectomy. Methods:Patients from the National Cancer Centre Singapore, who were eligible for BCT but chose mastectomy without reconstruction, between December 2014 and December 2015 were included. An interviewer-administered questionnaire focusing on patients' reasons for choosing mastectomy over BCT and not opting for immediate breast reconstruction after mastectomy was used. Tumour characteristics were retrieved from medical records. Spearman's rank correlation coefficient, Mann-Whitney U and Kruskal-Wallis tests were used to analyse the correlation between the patient's self-rated influential factors and variables. Statistical significance was taken as P?

SUBMITTER: Lee WQ

PROVIDER: S-EPMC6354187 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Factors influencing patient decision-making between simple mastectomy and surgical alternatives.

Lee W Q WQ Tan V K M VKM Choo H M C HMC Ong J J Krishnapriya R R Khong S S Tan M M Sim Y R YR Tan B K BK Madhukumar P P Yong W S WS Ong K W KW

BJS open 20181008 1

<h4>Background</h4>Despite similar survival rates, breast-conserving therapy (BCT) remains a distant second choice after simple mastectomy for patients with early-stage breast cancer in Singapore. Uptake of reconstruction after mastectomy is also low (18 per cent). The aim of this study was to explore the factors influencing a patient's choice for mastectomy when eligible for BCT, and why patients decline reconstruction after mastectomy.<h4>Methods</h4>Patients from the National Cancer Centre Si ...[more]

PMID: 30734013

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Project description:BackgroundShared decision-making, a communicative process to reach decisions based on informed preferences, evidence, and co-created goals, improves care satisfaction and patients' quality of life. However, shared decision-making has not been widely implemented in long-term care facilities, and few studies have examined how to promote the shared decision-making practice. This study aimed to identify the influencing factors of shared decision-making based on the Person-centered Practice Framework in long-term care facilities.MethodsA total of 300 staff (nursing staff, social workers, and personal care workers) in 13 Korean long-term care facilities participated in this study. Data from 280 respondents were finally analyzed, excluding respondents with missing values. Data were collected using structured questionnaires that included items on shared decision-making, personal factors (e.g., knowledge about dementia, person-centered care education, person-centered attitude, communication behavior, and job tenure), and care environment factors (e.g., person-centered climate, staffing level, effective staff relationships, supportive supervisors, and power-sharing). Multilevel linear regression analyses were performed using Mplus Version 8.8.ResultsThe mean shared decision-making score was 35.78 (range 8-45). Staff with experience of person-centered care education (β = 0.198, p = 0.034), a higher person-centered attitude score (β = 0.201, p = 0.007), and a higher communication behavior score (β = 0.242, p < 0.001) were more likely to report a higher shared decision-making score. In addition, staff who viewed their care environment as more person-centered were more likely to report a higher shared decision-making score (β = 0.416, p < 0.001).ConclusionsThis study highlights that personal (e.g., person-centered care education, person-centered attitude, and communication behavior) and care environment (e.g., person-centered climate) factors could influence shared decision-making for long-term care residents. These findings could be foundational evidence for facilitating shared decision-making practice in long-term care settings.

Project description:ObjectiveThere was increasingly demand of participation in surgical decision-making among Chinese patients with prostate cancer. However, due to the complex healthcare system and advanced care settings, it is quite challenging for the patients to gain sufficient support from the institute and the government. This research aimed to investigate the factors that impact the degree of participation in surgical decision-making among Chinese prostate cancer patients.MethodsA phenomenological approach of qualitative research based on the results of semi-structured interviews was adopted, to explore the influencing factors which hinder the participation in surgical decision-making. Consolidated Criteria for Reporting Qualitative Research were utilized. Up to 160 post-operative patients who had undergone radical prostatectomy along with 68 medical and nursing staffs, were purposively recruited in this research. This retrospective study was carried out from September 2018 to August 2019. After recording and transcribing the interviews, the interview materials were evaluated via the Colaizzi's seven step approach and the NVivo Version 10 software to analyze the interview content.ResultsAccording to the analysis and summary of the interviews, there were three factors affecting the degree of participation in surgical decision-making. Firstly, insufficient information was provided by medical and nursing staffs because of their lack of time, proper communication skills, and career experience, as well as difficulties in the development of patient decision aid and inconsistent resource availability. Secondly, the cognitive level of decision-making among patients was relatively low due to poor psychological endurance, insufficient amount of education, senility, and less knowledge and information demand. Ultimately, decisions were constantly made by family members with/without patients.ConclusionsThe degree of participation of Chinese prostate cancer patients in the surgical decision-making had much space for improvement.

Project description:Background The organ transplantation sector in China is facing a severe shortage of donors, and the organ donation rate needs to be increased. Since 2015, voluntary donation by citizens has become the only source of organs for transplantation in China. In recent years, there has been a relatively positive change in young people's attitudes toward organ donation after death. The aim of the study was to understand young people's perceptions and attitudes toward organ donation and the factors that influence them and can positively impact the promotion of organ donation. Methods By analyzing relevant literature and legal texts, we developed a questionnaire. Information was obtained through questionnaires and interviews, and 501 valid questionnaires were returned from the target group. A chi-square test was used to examine whether there were significant differences in the willingness to organ donation among young people with different characteristics. A factor analysis was used to investigate the main factors influencing the different attitudes of young people toward organ donation, and a one-way ANOVA was used to examine whether young people with different characteristics were affected differently by different factors. Results In our survey of young people aged 18–30 years, 99.2% of respondents knew about organ donation, 47.1% were willing to donate organs, and 15.2% understood that there were corresponding laws and regulations for organ donation. The study's findings showed that urban residents are more willing to be organ donators than rural residents; people with higher education levels have better awareness and are more willing to donate an organ; and people with religious beliefs are more likely to donate organs. The main factors that support the willingness of young people to donate are the social environment that provides support, their optimism in dealing with death, and their desire to realize their final value after death. The main factors for those unwilling to donate were low awareness or misconceptions about organ donation among individuals and their families and their attitudes toward death. As the people who took the questionnaire are probably interested in organ donation, the sample results will show a higher percentage of people who know about organ donation. We hope to discuss further with a larger and broader sample coverage to improve the estimates' validity and reflect the overall picture more accurately in a future study. Conclusion Young people knew about organ donation but had a low depth of awareness. Household registration type, education level, and religious affiliation significantly correlate with people's willingness to donate. The supportive environment for organ donation in society and the correct understanding of the organ donation process and laws and regulations can influence people's willingness to donate.

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Factors influencing patient decision-making between simple mastectomy and surgical alternatives.

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Factors influencing patient decision-making between simple mastectomy and surgical alternatives.

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