定性主题分析探讨了中国年轻人在低风险乳头甲状腺癌管理方面的决策经验

背景：甲状腺癌是中国最常见的内分泌肿瘤。有关患者参与共同决策（SDM）过程程度的问题；这与考虑低风险甲状腺甲状腺癌（PTC）的治疗选择的患者尤其重要。在这项研究中，我们旨在探索中国年轻人的SDM经历，该经验与低风险PTC的治疗方法有关。方法：该研究使用了定性的描述性设计和半结构化访谈。在2023年3月至2024年5月之间，对24例患者进行了24例患者（年龄范围为18至38岁； 4名男性和20名女性）。最大的肿瘤大小为1.47厘米。反思性主题分析用于从转录的访谈中识别关键主题。结果：分析表明，低风险PTC的年轻患者的SDM体验涉及四个主题：信息共享的挑战；寻求信息的原因；影响决策的因素；和治疗决策中的自我定位。确定了与治疗决策有关的三个自我定位。这些包括依赖定位，反映了“家长式”决策模式；协作定位，反映了决策的“共享”；和自主定位，反映出对管理健康和决策的参与的个人责任感增加。提供的治疗方案有限，过度使用医学术语以及临床医生与患者之间的沟通差距是信息共享过程中描述的主要挑战。在医师咨询后需要持续存在的信息导致积极的信息寻求行为。本研究中确定的关键变量可能影响决策过程，是未来的个人考虑，用于讨论癌症的语言和负面情绪。结论：这些结果突出了在支持低风险PTC的医生互动的背景下支持协作治疗决策时采用灵活策略的必要性。根据这些发现，临床医生可以通过查询患者的角色偏好，提供各种治疗选择的细节，并鼓励患者分享与可能的治疗方案有关的偏好和关注点，以提高SDM的质量。

Background: Thyroid cancer is the most common endocrine neoplasm in China. Questions regarding the extent of patient involvement in shared decision-making (SDM) processes persist; this is particularly pertinent to patients considering treatment options for low-risk papillary thyroid cancer (PTC). In this study, we aimed to explore Chinese young adults' experiences of SDM relating to the choice of treatment for low-risk PTC. Methods: The study used a qualitative descriptive design and semistructured interviews. Interviews were conducted with 24 patients (ages ranging from 18 to 38 years; 4 men and 20 women) diagnosed with low-risk (PTC) between March 2023 and May 2024. Twenty-two of 24 patients' tumor size measured 1 cm or smaller; the largest tumor size measured 1.47 cm. Reflexive thematic analysis was used to identify key themes from the transcribed interviews. Results: The analysis revealed that the SDM experiences of young patients with low-risk PTC involve four themes: challenges in information sharing; reasons for information seeking; factors influencing decision making; and self-positioning in treatment decision making. Three self-positions relating to treatment decision making were identified. These included dependent positioning, which reflects a "paternalistic" decision-making pattern; collaborative positioning, reflecting a "sharing" of decision making; and autonomous positioning, reflecting an increased sense of personal responsibility for both managing their health and engagement in decision making. Limited treatment options being offered, overuse of medical terminology, and communication gaps between clinicians and patients were the main challenges described during the information-sharing process. Information that needs persisting after physician-patient consultations resulted in active information-seeking behavior. The key variables identified in this study that potentially affected the decision-making process were future personal considerations, language used to discuss cancer, and negative emotions. Conclusions: These results highlight the necessity of adopting flexible strategies when supporting collaborative treatment decision making in the context of the doctor-patient interaction for low-risk PTC. Based on these findings, clinicians can take measures to enhance the quality of SDM by inquiring about patients' role preferences, providing details of the full range of treatment options, and encouraging patients to share their preferences and concerns relating to possible treatment options.