Shared Decision-making in Patients with Primary Liver Cancer During Perioperative Period
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摘要:
目的 探讨医护患共同决策模式在原发性肝癌患者围手术期的应用效果。 方法 选取2020年11月1日至2021年4月30日期间120例原发性肝癌治疗选择腹腔镜肝叶切除术的患者，随机分为对照组和实验组各60例。对照组患者围手术期采用常规健康干预模式，而实验组患者采用医护患共同决策模式。对2组患者围手术期的心理痛苦程度（采用心理痛苦温度计）、焦虑抑郁程度（采用HADS量表）、术后生活自理能力（日常生活能力评定表）及遵医行为、住院时间、医护满意度、复诊率进行比较。 结果 除实验组与对照组患者在入院时的心理状态和自理能力，差异无统计学意义（P > 0.05），术后的心理痛苦、焦虑抑郁程度；术后生活自理能力、患者遵医行为、住院时间、医护满意度、复诊率都明显优于对照组，差异有统计学意义(P < 0.05)。 结论 对原发性肝癌行腹腔镜肝叶切除围手术期的患者实施医护患共同决策健康干预模式，可减轻患者心理痛苦、缓解患者焦虑抑郁程度、提高术后生活自理能力、提高其遵医行为、缩短住院时间、对促进康复是安全有效，是值得临床推广和借鉴的。 -
关键词:
- 医护患共同决策模式 /
- 原发性肝癌 /
- 腹腔镜肝叶切除围手术期
Abstract:Objective To investigate the effect of the shared decision-making in patients with primary liver cancer during perioperative period. Methods A total of 120 patients with primary liver cancer who underwent laparoscopic hepatectomy from November 1, 2020 to April 30, 2021 were selected and randomly divided into control group （n = 60） and experimental group （n = 60）. The patients in the control group were treated with routine health intervention mode during perioperative period, while the patients in the experimental group were treated with the patient-nurse shared decision-making mode. The psychological pain degree （distress thermometer, DT）, the hospital anxiety and depression degree （HADS）, postoperative self-care ability (ADL), compliance behavior, length of hospital stay, patient satisfaction and follow-up visit rate were compared between the two groups. Results There was no significant difference in the psychological state and self-care ability between the experimental group and the control group （P > 0.05）; Postoperative self-care ability, patient compliance behavior, length of hospital stay, medical satisfaction, follow-up visit rate were significantly better than the control group, the difference was statistically significant （P < 0.05）. Conclusion Shared decision-making for primary liver cancer patients undergone laparoscopic hepatectomy is beneficial in reducing psychological distress, relieving patients’ anxiety depression, improving postoperative life self-care ability and improving the medical behavior, shortening the length of hospital stay, which is both safe and efficient for patients’ recovery, and is worthy of clinical promotion and reference. -
表 1 2组入院时、术前、术后、出院后的心理痛苦程度比较[（
$\bar x \pm s$ ），分]Table 1. Comparison of the degree of psychological pain between the two groups at admission，before operation，after operation and after discharge [（
$\bar x \pm s$ ），scores]组别 n 入院时 术前 术后 出院后 实验组 60 5.85 ± 1.38 2.93 ± 1.13 2.32 ± 0.10 2.23 ± 0.89 对照组 60 5.80 ± 1.86 3.50 ± 1.08 3.43 ± 1.14 4.00 ± 1.21 t 0.196 −2.883 −6.060 −9.566 P 0.845 0.005 0 0 
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表 2 2组入院时、术前、术后、出院后的焦虑抑郁程度比较[（
$\bar x \pm s$ ），分]Table 2. Comparison of anxiety and depression between the two groups at admission，before operation，after operation and after discharge [（
$\bar x \pm s$ ），scores]组别 n 入院时 术前 术后 出院后 实验组 60 9.22 ± 3.56 6.68 ± 2.94 7.61 ± 2.08 7.72 ± 1.90 对照组 60 9.25 ± 3.54 8.17 ± 2.67 8.09 ± 2.15 9.17 ± 1.93 t −0.049 −2.693 −3.013 −3.934 P 0.961 0.009 0.003 0
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表 3 2组入院时、术前、术后、出院后的生活自理能力比较[（
$\bar x \pm s$ ），分]Table 3. Comparison of self-care ability at admission，before operation，after operation and after discharge between the two groups[（
$\bar x \pm s$ ），scores]组别 n 入院时 术前 术后 出院后 实验组 60 98.58 ± 3.69 98.67 ± 3.55 75.25 ± 11.45 97.17 ± 4.82 对照组 60 98.75 ± 2.70 98.83 ± 7.82 69.92 ± 7.84 93.92 ± 5.68t t −0.049 −1 −0.559 3.296 P 0.621 0.321 0 0.002
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表 4 2组患者遵医行为、住院时间、医护满意度、复诊率比较（
$\bar x \pm s$ ）Table 4. Comparison of compliance behavior，length of stay，satisfaction of doctors and nurses，and return visit rate between the two groups（
$\bar x \pm s$ ）组别 n 遵医行为
（%）住院时间
（d）医护满意度
（%）复诊率
（%）实验组 60 97.60 ± 1.53 8.63 ± 1.06 98.78 ± 1.12 94.43 ± 0.23 对照组 60 91.20 ± 2.83 9.52 ± 0.97 96.45 ± 1.67 91.42 ±0.28 t 11.770 −9.264 3.286 4.499 P 0 0 0.002 0
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