基于“渥太华决策支持框架”的乳腺癌患者乳房再造手术决策辅助工具的编制  

Development of a decision support tool for breast reconstruction for breast cancer surgery based on Ottawa decision support framework

作　　者：王小媛 张青月 闫迪 王燕 强万敏 Wang Xiaoyuan;Zhang Qingyue;Yan Di;Wang Yan;Qiang Wanmin(Department of Breast Oncoplastic Surgery,National Clinical Research Center for Cancer,the Sino-Russian Joint Research Center for Oncoplastic Breast Surgery,Tianjin Clinical Research Center for Cancer,Key Laboratory of Breast Cancer Prevention and Therapy,Tianjin Medical University Cancer Institute and Hospital,Tianjin 300000,China;Department of Nursing Administration,National Clinical Research Center for Cancer,the Sino-Russian Joint Research Center for Oncoplastic Breast Surgery,Tianjin Clinical Research Center for Cancer,Key Laboratory of Breast Cancer Prevention and Therapy,Tianjin Medical University Cancer Institute and Hospital,Tianjin 300000,China)

机构地区：[1]国家恶性肿瘤临床医学研究中心、中俄乳腺肿瘤整形联合研究中心、天津市肿瘤防治重点实验室、天津市恶性肿瘤临床医学研究中心、天津医科大学肿瘤医院乳房再造科,天津300000 [2]国家恶性肿瘤临床医学研究中心、中俄乳腺肿瘤整形联合研究中心、天津市肿瘤防治重点实验室、天津市恶性肿瘤临床医学研究中心、天津医科大学肿瘤医院护理部,天津300000

出　　处：《现代临床护理》2024年第8期1-10,共10页Modern Clinical Nursing

基　　金：天津市“项目+团队”重点培养专项,乳腺肿瘤整形智能医学研发转化项目,项目编号XB202008;天津市医学重点学科(专科)建设项目,项目编号TJYXZDXK-011A;中华护理学会2022年度科研课题,项目编号ZHKYQ202205;天津医科大学肿瘤医院院级课题,项目编号H2003。

摘　　要：目的开发基于循证的、符合中国本土特色的乳腺癌乳房再造手术决策辅助工具,为临床开展决策制定提供思路,推动共享决策的实施。方法以“渥太华决策支持框架(the Ottawa decision support framework,ODSF)”作为理论基础,以“患者决策辅助工具国际标准4.0版(IPDAS4.0)”作为标准框架,通过文献回顾形成乳腺癌乳房再造手术决策辅助工具初版;邀请18名乳腺癌与乳房再造领域的临床与护理专家展开2轮德尔菲函询后形成工具修订版;之后在临床中对5名患者及5名家属进行试运用,整合意见后确定工具终版。结果基于文献回顾整合证据形成工具初版含7项一级指标、14项二级指标,49项三级指标;第一轮三级指标函询各条目的重要性均分为4.06~4.94分,变异系数为0.05~0.22,满分比0.53~0.88;第二轮三级指标函询各条目的重要性均分为4.71~4.94分,变异系数为0.05~0.15,满分比为0.72~1.00;第二轮一、二、三级指标Kendall协调系数W分别为0.509、0.437、0.425,最终形成乳腺癌乳房再造手术决策辅助工具终版,包含7项一级指标(决策评估、疾病信息支持、风险利益分析、决策支持系统、平衡价值与偏好、促进决策制定、评价决策质量),14项二级指标,50项三级指标。经临床试运用,取得较好效果。结论基于“渥太华决策支持框架”的乳腺癌乳房再造手术决策辅助工具具备科学性和临床实用价值,可为乳腺癌患者在面对乳房再造手术方式选择困难时提供解决思路。Objective To develop a evidence-based and local decision supporting tool for breast reconstruction for breast cancer surgery based on Ottawa decision support framework to guide clinical decision-making and promote the implementation of shared decision-making.Methods Based on Ottawa decision support framework and International Patient Decision Aid Standards 4.0(IPDAS4.0),the initial version of breast reconstructive surgery decision support tool was proposed through a literature review.Eighteen clinical and nursing experts specialised in breast cancer and breast reconstruction were invited to participate in 2 rounds of Delphi consultations and resulted in a revised version of the tool.Following a pilot test involving 5 patients and 5 family members in clinical settings,their feedback was integrated into the revised version to create a final version of the tool.Results The initial version of the tool were developed based on the literature review and evidence synthesis,comprising 7 primary indicators,14 secondary indicators and 49 tertiary indicators.In the first round of consultation on the 3-tier indicators,the average importance scores ranged from 4.06 to 4.94,with coefficients of variation were 0.05-0.22,and proportions of full marks ranged from 0.53 to 0.88.In the second round of consultation on the 3-tier indicators,the average importance scores ranged from 4.71 to 4.94,with coefficients of variation were 0.05-0.15,and proportions of full marks ranged from 0.72 to 1.00.Kendall's W coefficients for the primary,secondary and tertiary indicators in the second round were 0.509,0.437,and 0.425,respectively.The finalised decision support tool for breast cancer and breast reconstruction included 7 primary indicators covering decision evaluation,disease information support,risk and benefit analysis,decision support system,balance value and preference,promotion of decision making,evaluation of decision quality,alongside 14 secondary indicators and 50 tertiary indicators.Clinical trials confirmed the finalised effectiven

关 键 词：乳腺癌 乳房再造术 渥太华决策支持框架 决策辅助工具 德尔菲法 

分 类 号：R473.73[医药卫生—护理学]