探索中国年轻成人在低风险乳头状甲状腺癌管理决策中的体验：一项定性主题分析

背景：甲状腺癌是中国最常见的内分泌肿瘤。关于患者在共同决策（SDM）过程中的参与程度仍存在疑问，尤其是考虑低风险乳头状甲状腺癌（PTC）治疗方案的患者。本研究旨在探索中国年轻成人在低风险PTC治疗选择中的SDM体验。方法：采用定性描述性设计和半结构化访谈。2023年3月至2024年5月期间，访谈了24名诊断为低风险（PTC）的患者（年龄18至38岁；其中4名男性，20名女性）。其中22名患者的肿瘤直径均≤1厘米，最大肿瘤直径为1.47厘米。采用反思性主题分析法，从转录访谈中识别关键主题。结果：分析显示，低风险PTC年轻患者的SDM体验涉及四个主题：信息共享的挑战、信息获取的原因、影响决策的因素以及在治疗决策中的自我定位。还识别出三种与治疗决策相关的自我定位，包括：依赖型，表现为“父权式”决策模式；合作型，体现为“共享”决策；自主型，表现为增强的个人责任感，主动管理健康并参与决策。在信息分享过程中，主要面临有限的治疗选择、过度使用专业术语以及医患沟通存在差距等挑战。患者在咨询后持续需要的信息，促使其积极主动寻找信息。影响决策的关键变量包括未来个人考虑、讨论癌症时使用的语言以及负面情绪。结论：结果强调在低风险PTC的医患互动中支持合作治疗决策时采用灵活策略的必要性。基于这些发现，临床医生可以通过询问患者的角色偏好、提供全方位的治疗选择信息，以及鼓励患者表达他们的偏好和担忧，来提升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.