Relationship Between Decision Conflict and Decision Regret Among Postoperative Breast Cancer Patients in China: the Regulating Role of Decision-making Preparation

doi:10.21203/rs.3.rs-442596/v2

Objective: Different surgical methods have different risks and benefits.Chinese breast cancer(BC) patients’ decision-making of surgical treatment becomes a critical research question. Patients are often offered several options before surgery, and decision preparation plays an important role in the decision process. However some patients regret the original decision afterward. To understand the current situation, this study explore mainly explores the status of decision regret among postoperative breast cancer patients,and tests the relationship between decision conflicts, decision-making preparation, and decision regret.

Methods: A cross-sectional survey was carried out. Totally 320 postoperative BC patients were studied using a self-made general data scale, Decision Regret Scale, Decision Conflict Scale, and Preparation for Decision Making Scale. Basic descriptive analyses, Pearson’s correlation analyses and regression analyses were performed.

Results: The average score of decision regret among BC patients after surgery was 34.28. Decision regret was positively associated with decision conflict (r=0.853, p<0.01), and negatively associated decision preparation (r=-0.404, p<0.01). Decision-making preparation plays a regulatory role for the emergence of decision conflicts and regrets. The correlation between decision conflicts and decision regret increases with the increase in decision-making preparation.

Conclusion: The adverse effects of decision conflicts on decision regret gradually increase with the increase in decision-making preparation. Results indicate that reducing decision preparation can be expected to improve the level of decision regret among Chinese postoperative BC patients.Thus, Clinical staffs should encourage patients to take an active part in decision-making, provide specialized information support, and improve the level of decision regret among Chinese BC patients after surgery.

Cancer Biology

Breast cancer

Decision regret

Decision conflict

Decision preparation

Breast cancer is the most common cancer in women worldwide. According to global cancer data in 2020, there are more than 2.26 million new cases of breast cancer each year, accounting for 11.7% of all tumors[1].In China, the median age of diagnosis is 48–50 years old, and the 5-year survival rate has reached 85–88%[2]. Surgical treatment is part of the important methods for comprehensive treatment of breast cancer patients.The surgical decision-making is a complicated and difficult progress for Chinese BC. Breast-conserving surgery and breast reconstruction have become milestones in surgical treatment. The rate of breast-conserving in USA was 64.5% [3, 4]and the rate of breast reconstruction was 40%; however, The majority of BC patients in China are still dominated by mastectomy, and 20–40% chose breast-conserving and only 10.7% chose breast reconstruction [3, 5].Different surgical methods proved to have an impact on the quality of life[6]. Therefore, the Chinese BC patients’ decision-making of surgical treatment becomes a critical research question.

In china, cancer is a family event. Facing with many treatment decisions, BC patients always require to weigh efficacy, safety, post-operation complications, cost, quality of life and follow-up treatment [7]. Besides, the decision-making progress were influenced by family factors, traditional culture and fatalism[8]. When confronted with surgical decision, BC patients always experienced anxiety, illness uncertainty, depresses, hesitation and decision conflict[9].Facing numerous treatment options, BC patients experienced moods fluctuate and always given the decision-making right to physicians, which just considered survival time and didn’t consider patients’ preference[10]. A survey showed 6–23% of cancer patients experience decision regret[11]. Therefore, different surgical decision-making may contribute to different quality of life and body image.

Decision regret is a measure of the quality of decision making. Regret was often considered to be negative psychological and emotional feelings related to considering a past or future choice[11, 12].Prior studies have shown that the active involvement in treatment decision can get more satisfaction about decision-making process[13, 14]. In China, almost all patients follow the traditional paternalistic medical decision-making model and this decision-making model ignores the patient's right of informed consent [15]. Influenced by traditional medical environment, more patient play a passive role in decision-making progress and tend to let the physicians or family members make a treatment decision in China[8]. The decision regret associated with various factors including lack of treatment information, individual value, personality traits, decision conflict, decision attitudes and cultural factors[16, 17]. Berry et al.'s research has demonstrated that if patients make decisions with insufficient participation, in the long run the probability of regret will increase and the quality of decision-making will decrease[18]. Share decision-making is the peak form of patient-centered care, which encourage patients actively participate in their own treatment decisions[19]. The surgical options are a challenging and perplexing process and largely depend on each patient’s personal values and preferences. Even though some research conducted in other countries, little knows about the decision regret, influencing factor and mechanism among newly diagnosed BC patients in China.

This study mainly explores the status of decision regret among newly diagnosed BC patients,and tests the relationship between decision conflicts, decision preparation, and decision regret. The hypothetical model is shown in Fig. 1, which details treatment decisions for breast cancer patients. Further information will provide a theoretical basis for improving patients’ ability to make relevant decisions.

Participants

A convenient sampling method was utilized to recruit participants from the Breast Reconstruction Ward of the Tianjin Cancer Hospital from May to October in 2018. The inclusion criteria for selection included: (1)aged 18 years or older. (2)newly diagnosed as stage I-II BC within the last 6 months. (3)underwent breast cancer surgery. Exclusion criteria included: (1) had other malignant tumors in the past; (3)have an additional acute cardiopulmonary dysfunction, (4)being cognitively impaired, and/or having a mental illness. A total of 320 women were enrolled and they all signed the informed consent. This study was approved by the Institutional Review Board of Tianjin Cancer Hospital, Tianjin, China.

Measures

The demographic questionnaire was self-designed by the researcher to collect patients’ demographic and clinical characteristics. The information collected was age, religious beliefs, occupational status, educational level, marital status, medical expenses, surgical decision-makers, and disease details.

Decision Regret

The Decision Regret Scale was developed by Brehaut [20]in 2003 to assess the level of regret of a patient's treatment-related decision after surgery. This scale consist of 5 items and each item was rated on a 5-point Likert scale, with 1 for complete agreement and 5 for complete disagreement. The score of item is subtracted from the raw score and the result is multiplied by 25. The total(mean) score range from 0 to 100, with a higher score indicating patient's more decision regret. The Chinese scale has good reliability and validity, with a Cronbach’s α of 0.86[21]. It has been widely used in breast cancer patients.The Cronbach's α coefficient in this study was 0.834.

Decision Conflict

The Decision Conflict Scale was used to assess the uncertainty about choices, factors that lead to decision conflicts, and perceptions of effective decision-making[22]. The study used a Chinese version of Decision Conflict Scale by Li [23].The scale consists of 16 items and 16 items are divided into 3 dimensions: decision uncertainty (3 items), factors leading to decision uncertainty (9 items), and perceived effectiveness of decisions (4 items). The scale uses the 5-point Likert scale from 0–4 (from strongly agree to strongly disagree). the total score ranges from 0–64. The total converted score firstly was summed all item scores, then was divided by 16 and multiplied by 25. The total converted score range from 0-100, with a higher score indicating a higher level of decision conflict [24]. Total score of less than 25 is considered as absence of a decision-making dilemma. More than 37.5 indicated the presence of a decision-making dilemma, which often delays decisions.The Chinese scale has good reliability and validity, with a Cronbach’s alpha of 0.941. And the Cronbach's α coefficient in this study was 0.926.

The Preparation of decision-making

Preparation for Decision Making Scale (PrepDM) was developed by Bennett[25]in 2010 to assess patients’ perceptions during the decision-making process. The Chinese version of Decision Preparation Scale [23] was translated by Li. The scale consists of 10 items. Each item used 5-point Likert scale from 1–45(from not at all to a great deal). The Chinese version of the Preparation for Decision Making questionnaire contained 10 items. The score of each item is added to the mean value, multiplied by 20, and converted to 0-100 points. A total score of more than 60 points indicates better decision preparation. The Cronbach's α coefficient in this study was 0.916.

Data collection method

The researchers instructed the patients to carefully read the questionnaire instructions and explained this purpose and significance of the research. Each patient completed the questionnaire independently and the questionnaire was collected on the spot. All the participants signed informed consent. 330 patients met the inclusion criteria were included in the study. Of these patients, 10 refused to participate in the study and did not sign the informed consent form. Thus, 320 included in the final analysis.

Statistical Analysis

Data analysis was performed by SPSS 20.0 and STATA 15.0. Statistical significance was set at P < 0.05. The means (standard deviations) and frequencies (percentages) were used to describe the characteristics of the participants. Pearson’s correlation analyses were used to exam the relationship among decision regret, decision conflict and decision preparation. Multivariate stepwise regression analysis was used to find the influencing factors of decision regret, and to exam whether decision-making preparation regulates the relationship between decision conflict and decision regrets when demographic and clinical characteristics were controlled in regression model. If the moderation effect of decision-making preparation exists, then the Johnson-Neyman technique was applied to explore the conditional effect of decision regret on decision conflict across the range of decision-making preparation.

330 patients participate in this survey and 320 questionnaires were effective with a response rate of 97%. The participant aged between 25 and 76 years, mean age was 49.25 years (SD = 10.26). Only 12.5% patients have religious belief. 91.25% patients married, and 176 patients(55%) made surgical treatment with family. But if give another chance, 147 patients(45.96%) want to make the decision by themselves. Meanwhile,61.25% patients didn’t do decision preparation.The distribution of demographic characteristics is shown in Table 1.

Table 1

Participants’ characteristics
Variable	N (%)
Stage
I	83(25.94)
II	237(74.06)
Age(years)
≤ 40	52(16.25)
41–50	140(43.75)
51–60	79(24.69)
> 60	49(15.31)
Religious
Yes	40(12.5)
No	280(87.5)
Educational level
≤Elementary	44(13.75)
Junior high school	90(28.13)
High school	88(27.5)
College	92(28.75)
Graduate or above	6(1.9)
Income(yuan)
< 1000	41(12.81)
1000–3000	114(35.63)
3000–5000	111(34.69)
5000–10000	35(10.94)
> 10000	19(5.94)
Occupation status
Yes	117(36.56)
No	203(63.44)
Marital status
Married	292(91.25)
Unmarried	9(2.81)
Widowed/Divorced	19(5.94)
Medical expenses
Rural medical insurance	75(23.44)
Town medical insurance	217(67.81)
Other	28(8.75)
Operation
Mastectomy	176(55.00)
Breast conserving surgery	78(24.38)
Breast reconstruction	66(20.62)
Primary decision-maker
With family	176(55.00)
Patient himself	36(11.25)
Doctors	108(33.75)
Who you want to make surgical decision if we give you another choice
With family	104(32.5)
Patient himself	147(45.94)
With Doctors	69(21.56)
Decision-making conflict
< 25	28(8.75)
25-37.5	192(60.0)
> 37.5	56(17.5)
Decision-making preparation
≤ 60	196(61.25)
> 60	124(38.75)

Decision regret scores of post-operation breast cancer patients

The average score of 320 participants’ postoperative decision regret was 34.28 (SD = 20.18), the mean score of decision conflict was 28.41(SD = 6.99), and the average score of decision-making preparation was 57.34(SD = 20.77).

Bivariate Correlations Among the main variables

Pearson correlation analysis showed that decision regret was positively associated with decision conflict (r = 0.853, p < 0.01), and negatively associated decision preparation (r=-0.404, p < 0.01). Further, decision conflict was negatively related to decision preparation (r=-0.524, p < 0.01).

The regulating effect of decision preparation on the relationship between decision conflict and decision regrets

Controlling all demographic and clinical characteristics in the analysis process, the results showed that decision-making preparation played a regulatory role in the emergence of decision conflict and decision regret (decision-making preparation × decision conflict: β = 1.408, p < 0.05); the detailed results are shown in Table 2.

Table 2

Analysis of the adjustment effect of decision-making preparation between decision-making conflicts and decision-making regrets
Variable	Step 1		Step 2
Variable	β	SE	β	SE
Decision-making conflict	15.326**	0.984	15.918**	1.016
Decision-making preparation	0.587	0.817	1.092	0.846
Decision-making conflict × Decision-making preparation			1.408*	0.654
R²	0.798		0.801
△R²	0.798		0.003
F	46.382**		45.326**
Note: All demographic variables were adjusted. p<0.05;*p<0.01

The Johnson-Neyman technique was used to further explore the boundary value of the decision-making preparation adjustment effect and the range of the statistically significant decision-making preparation. Analysis found that the correlation between decision conflicts and decision regret increases with the increase in decision-making preparation, indicating that the adverse effects of decision conflicts on decision regret gradually increase with the increase in decision-making preparation. The 95% confidence interval does not include 0, as showed in Fig. 2.

The results of this study showed that the postoperative decision regret score of 320 breast cancer patients was 34.289(SD = 20.18), which was higher than the decision regret level in Chinese American women with BC[21]. The reasons could be that the inclusion population lived in different countries and shares a different medical information. In China, BC patients played a passive role in decision progress, and they didn’t have enough time to do a preferred decision because of the heavy patient’s burden in the hospital[10]. A qualitative research have found that Chinese BC patients only consider the survival and financial burden during the treatment period[8]. And Chinese patients ignored the aesthetic effect, quality of life or other long-term effects in the postoperative phase.In USA, the decision regret is associated with financial barriers and consultation limitation by language[21]. Our finding is similar with several investigation [11, 26]which are carried on BC patients aiming to exam the level of decision regret after surgery.Because of traditional culture and patients’ perception, mastectomies is the best treatment in economic cost and survival in China[27, 28]. one research found that younger patients experienced more decision regret[11], because they experienced fewer fertility concerns. In addition, the study also found women who engaged in a contract or part-time work had a lower probability of experiencing decision regret than women with working full-time[11]. Because of the heavy medical burden in China, BC patients built a poor communication with clinicians and had no time to discuss the type of cancer, treatment, and a person's preferences and perceptions of treatment choices[30–33]. \With the spread of shared decision making, the physicians encourage patients to positively participate in treatment decision aiming to meet patients' needs and preference[27]. Therefore, health professionals build a systematic shared decision-making model to provide adequate information and enough decision-making time,do a high-quality decision and relieve the level of decision regret.

This study showed that decision conflict had a signification relationship with decision regret. Meanwhile, decision-making preparation had a regulatory effect between decision conflicts and decision regret. The results reveals that the influence of decision conflicts on decision regret increases with decision-making preparation increases, which is similar with our hypothesis. Cohan investigated the influencing factors of decision regret, and found decision conflict have a direct effect on decision regret[34].Decision-making is a complex process, and there is many influenced factor such as social statistics and clinical characteristics, expectations, values, decision conflicts, social support, decision-making roles, and personal resources[27].These include the decision of mastectomy vs. lumpectomy, whether to pursue contralateral prophylactic mastectomy, and whether to pursue reconstructive surgery[35]. These decisions require women to weigh the risks and benefits, recovery time and short and long-term effects associated with the different surgical options[36]. In China, more than 40% patients depend on physicians to make treatment decision and 62.8% patients make decision with family actually[37]. Majority of breast cancer patients had a knowledge gaps in surgical type, and negative changes in body image and sexual satisfaction were related with decision regret[38]. In addition, Ottawa's decision support theory based on decision conflict theory and social support theory[20] determined that participation competence is a prerequisite for the decision-making process. Chinese BC patients had a difficulty in communicating with physicians and clearly expressing their values or preference. The prerequisite for patients to participate in treatment decision-making included 2 basic conditions: 1) patients are willing to participate in treatment decisions; and 2) patients have the ability to participate in decision-making[39].Thus, medical staff should be decision-making guides,and provide specialization information support for breast cancer patients to increase decision preparation and eliminate decision conflict.

This study also found that greater decision conflict predicted a higher level of decision regret, and a similar result also found in a previous study[40]. The reason is that different surgical operation has different risks and benefits. Because there are no adequate information support to introduce costs, surgical sites, potential complications, and femininity with post-operation. However, the share decision-making model[26, 41] determined the importance of patients’ information needs before decision-making, and encourage patients actively participating in decision-making experience with less regret than women who delegate treatment decision-making to their physicians. A research showed that breast cancer treatment was widely selective and active, because various medical advice may make patients feel overwhelmed and they had a difficulty to understand medical information [42, 43]. A study in Australia showed that the Breast Reconstruction Decision Support Program significantly reduced decision conflicts and increased satisfaction with information [44]. Thus, Clinical nurses cannot blindly pursue the increase of patient participation and need to develop decision support interventions to improve patients' understanding about medial information. Meanwhile, our prior study found decision aids also reduce the level of decision regret by guiding decision-making and clarifying value preference[45]. Future studies should focus on the impact of the family on decision-making with breast cancer patients.

Limitations and Future Direction

There are some limitations in our study. Firstly, this was a descriptive cross-sectional study, the convenience sampling method instead of random sampling method was adopted. Secondly, only one hospital sample was selected which limited the representativeness of the samples. Thirdly, limited by time, this study is a cross-sectional rather than longitudinal design. Further study should be conducted to explore the decision regret, decision conflict and decision preparation in different time points of patients with breast cancer.

In summary, this study demonstrated the relationship among the three variables (decision preparation, decision conflict, and decision regret). Decision preparation was negatively associated with decision-conflicts and decision regret, and Decision preparation have a regulatory effect between decision conflicts and decision regret. As decision preparation increases, so did influence of decision conflicts on decision regret. Results indicate that reducing decision preparation can be expected to improve the level of decision regret among Chinese BC patients, by the regulatory role of decision preparation.

Funding:

This work was supported by Tianjin "The Belt and Road" Technological Innovation and Cooperation Grant (No.18PTZWHZ00050): The Sino‐Russian Joint Research Center for Oncoplastic Breast Surgery.

Conflicts of interest/Competing interests:

N/A

Availability of data and material:

N/A

Code availability:

N/A

Authors' contributions:

Yan Wang is responsible for the entire design and writing of the paper.Qingyue Zhang is responsible for part of the design and writing of the paper. Jianmei pang is responsible for the data analysis and writing of the paper. Liyuan Shi, Xiaoyuan Wang and Di Yan are responsible for data collection. Jian Yin is responsible for expert consultation on paper.Wanmin Qiang guides the design and writing of papers.

Ethics approval:

This study was approved by the hospital ethics committee (code numbe:bc2017024) to protect the rights of patients.

Consent to participate:

N/A

Consent for publication:

All authors expressed the authenticity of the data and agreed to be published in this journal. The work described has not been published previously, that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder.

IARC.(2020) LATEST GLOBAL CANCER DATA: CANCER BURDEN RISES TO 19.3 MILLION NEW CASES AND 10.0 MILLION CANCER DEATHS IN 2020[EB/OL]. https://www.iarc.fr/faq/latest-global-cancer-data-2020-qa/.
LI T, MELLO-THOMS C, BRENNAN P C.(2016) Descriptive epidemiology of breast cancer in China: incidence, mortality, survival and prevalence. Breast Cancer Research & Treatment, 2016,159(3): 395-406.
Wu J, Wang Y, Liu G, et al. (2020)The expert consensus on treatment about breast-conserving surgery [J].China Oncology, 30: 912-968.
Lee GK, Sheckter CC.(2018) Breast Reconstruction Following Breast Cancer Treatment-2018[J]..JAMA. 320:1277-1278.
Xiu Bingqiu, Guo Rong,Yang BenLong, et al. (2019)Current trends of breast reconstruction after mastectomy in China: a cross?sectional study. Chinese Journal of Oncology ,41:546-551.
Padmalatha S, Tsai YT, Ku HC, Wu YL, Yu T, Fang SY, Ko NY. (2021)Higher Risk of Depression After Total Mastectomy Versus Breast Reconstruction Among Adult Women With Breast Cancer: A Systematic Review and Metaregression. Clin Breast Cancer. 7:S1526-8209(21)00004-5.
Liu J, Hunter S, Zhu J, Lee RLT, Chan SW.(2021) Decision-Making Experience Related to Mastectomy Among Women With Breast Cancer: An Integrative Review. Cancer Nurs.
Wang L, Geng X, Ji L, Lu G, Lu Q. (2020)Treatment decision-making, family influences, and cultural influences of Chinese breast cancer survivors: a qualitative study using an expressive writing method. Support Care Cancer. 28:3259-3266.
Tang H, Wang S, Dong S, Du R, Yang X, Cui P, Liu W, Kou J, Chen C. Surgery decision conflict and its related factors among newly diagnosed early breast cancer patients in China: A cross-sectional study. Nurs Open. 2021 Feb 25. doi: 10.1002/nop2.791. Epub ahead of print. PMID: 33630425.
ZHENG Hongying, YANG Linning, YOU Tingting, HU Jiale, YANG Yan (2020).The barriers and facilitators of breast cancer patients' participation in Shared Decision-Making: a descriptive qualitative study[J]. Chinese Nursing Management,20(10): 1492-1496.
Yamauchi K, Nakao M, Nakashima M. Correlates of regret with treatment decision-making among Japanese women with breast cancer: results of an internet-based cross-sectional survey. BMC Womens Health. 2019 Jul 2;19(1):86.
Connolly T, Reb J: Regret in Cancer-Related Decisions. Health Psychology Official Journal of the Division of Health Psychology American Psychological Association 2005, 24(4 Suppl):S29.
Lantz PM, Janz NK, Fagerlin A, Schwartz K, Katz SJ(2005): Satisfaction with Surgery Outcomes and the Decision Process in a Population-Based Sample of Women with Breast Cancer. Health Services Research , 40:745-767.
Hack TF, Degner LF, Watson P, Sinha L(2010): Do patients benefit from participating in medical decision making? Longitudinal follow-up of women with breast cancer. Psycho Oncology, 15(1):9-19.
Hu Ziqi, Liu Junrong(2020).Value,Influencing Factors and Patient Decision Aid of Sharing Decision making[J].Medicine and Philosophy,4(639):1-6.
Schubart JR, Farnan MA, Kass RB. (2015)Breast Cancer Surgery Decision-Making and African-American Women. J Cancer Educ. ;30(3):497-502.
Barać I, Plužarić J, Ilakovac V, Pačarić S, Gvozdanović Z, Lovrić R. (2020)Personality traits of core self-evaluation as predictors on clinical decision-making in nursing profession. PLoS One. 15:e0233435.
Berry DL, Wang Q, Halpenny B, Hong F(2012)Decision preparation, satisfaction and regret in a multi-center sample of men with newly diagnosed localized prostate cancer. Patient Education & Counseling ,88(2).
Shinkunas LA, Klipowicz CJ, Carlisle EM(2020)Shared decision making in surgery: a scoping review of patient and surgeon preferences. BMC Med Inform Decis Mak. 12;20(1):190.
Brehaut JC, O'Connor AM, Wood TJ, Hack TF, Siminoff L, Gordon E, Feldman-Stewart D (2003) Validation of a decision regret scale. Med Decis Making. 23(4):281-92.
SY KL, MT K: Primary Breast Cancer Decision-making Among Chinese American Women(2015): Satisfaction, Regret. Nursing research , 64(5):391-401.
O'Connor, A. M. (1995). Validation of a decisional conflict scale. Medical Decision Making, 15(1), 25–30. https://doi.org/10.1177/0272989X95 01500105
Li, Y. (2017). Construction and application of treatment decision aids for early-stage primary liver cancer patients. The Second Military Medical University
AM OC.(1995) Validation of a decisional conflict scale. Medical decision making : an international journal of the Society for Medical Decision Making 1995, 15(1):25-30.
Bennett C, Graham ID, Kristjansson E, Kearing SA, Clay KF, O’Connor AM.(2010).Validation of a Preparation for Decision Making scale. Patient Education & Counseling ,78(1):130-133.
Wang AW, Chang SM, Chang CS, Chen ST, Chen DR, Fan F, Antoni MH, Hsu WY. (2018)Regret about surgical decisions among early-stage breast cancer patients: Effects of the congruence between patients' preferred and actual decision-making roles. Psychooncology. 27(2):508-514.
Covvey JR, Kamal KM, Gorse EE, Mehta Z, Dhumal T, Heidari E, Rao D, Zacker C. (2019).Barriers and facilitators to shared decision-making in oncology: a systematic review of the literature. Support Care Cancer. ;27(5):1613-1637. doi: 10.1007/s00520-019-04675-7.
Kuo NT, Kuo YL, Lai HW, Ko NY, Fang SY. (20019)The influence of partner involvement in the decision-making process on body image and decision regret among women receiving breast reconstruction. Support Care Cancer. 27(5):1721-1728.
Nicolai J, Buchholz A, Seefried N, Reuter K, Härter M, Eich W, Bieber C. (2016).When do cancer patients regret their treatment decision? A path analysis of the influence of clinicians' communication styles and the match of decision-making styles on decision regret. Patient Educ Couns. 99(5):739-46.
Wheeler SB, Reeder-Hayes KE, Carey LA.(2013) Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research. Oncologist. 18:986-93.
Siminoff LA, Graham GC, Gordon NH.(2006) Cancer communication patterns and the influence of patient characteristics: disparities in information-giving and affective behaviors. Patient Educ Couns. 62:355-60.
Lam WW, Kwok M, Chan M, Hung WK, Ying M, Or A, Kwong A, Suen D, Yoon S, Fielding R. (2014)Does the use of shared decision-making consultation behaviors increase treatment decision-making satisfaction among Chinese women facing decision for breast cancer surgery? Patient Educ Couns. 94(2):243-9.
Haltaufderheide J, Wäscher S, Bertlich B, Vollmann J, Reinacher-Schick A, Schildmann J.(2019) "I need to know what makes somebody tick …": Challenges and Strategies of Implementing Shared Decision-Making in Individualized Oncology. Oncologist. 24(4):555-562.
Cohan JN, Orleans B, Brecha FS, Huang LC, Presson A, Fagerlin A, Ozanne EM. Factors Associated With Decision Regret Among Patients With Diverticulitis in the Elective Setting. J Surg Res. 2021 May;261:159-166. doi: 10.1016/j.jss.2020.12.019. Epub 2021 Jan 8. PMID: 33429225.
Braude L, Kirsten L, Gilchrist J, Juraskova I. A systematic review of women's satisfaction and regret following risk-reducing mastectomy. Patient Educ Couns. 2017 Dec;100(12):2182-2189. doi: 10.1016/j.pec.2017.06.032. Epub 2017 Jul 1. PMID: 28732648.
Liu J, Hunter S, Zhu J, Lee RLT, Chan SW. Decision-Making Experience Related to Mastectomy Among Women With Breast Cancer: An Integrative Review. Cancer Nurs. 2021 Jul 21. doi: 10.1097/NCC.0000000000000981. Epub ahead of print. PMID: 34294647.
Hou X, Xu Z, Zhou Y, Lu Q, Pang D.(2014)Colorectal cancer patients' participant roles during operation treatment decision making process：a crosssectional study, Chinese Journal of Nursing,49（5):526.
Archangelo SCV, Sabino Neto M, Veiga DF, Garcia EB, Ferreira LM. Sexuality, depression and body image after breast reconstruction. Clinics (Sao Paulo). 2019 May 30;74:e883. doi: 10.6061/clinics/2019/e883. PMID: 31166474; PMCID: PMC6542498.
Katie Lee SY, Knobf MT. (2015)Primary Breast Cancer Decision-making Among Chinese American Women: Satisfaction, Regret. Nurs Res. 64:391-401.
Charles C, Gafni A, Whelan T.(1999) Decision-making in the physician–patient encounter: revisiting the shared treatment decision-making model. Social Science and Medicine.49(5):651-61.;
Okuhara T, Ishikawa H, Urakubo A, Hayakawa M, Yamaki C, Takayama T, Kiuchi T. (2018)Cancer information needs according to cancer type: A content analysis of data from Japan's largest cancer information website. Prev Med Rep. 212:245-252.
Nakashima M, Kuroki S, Shinkoda H, Suetsugu Y, Shimada K, Kaku T. (2012)Information-seeking experiences and decision-making roles of Japanese women with breast cancer. Fukuoka Igaku Zasshi. 103(6):120-30.
Parkinson B, Sherman KA, Brown P, Shaw LKE, Lam T.(2018). Cost-effectiveness of the BRECONDA decision aid for women with breast cancer: Results from a randomized controlled trial. Psycho Oncology.27(5).
Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L. (2017).Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev.4(4):CD001431.
Wang Y,Wang X, SHI L，Li J，Zhang Q，Yin Z. (2020)Development and application of decision aid of breast reconstruction surgery among breast cancer patients.55:90-95.

Relationship Between Decision Conflict and Decision Regret Among Postoperative Breast Cancer Patients in China: the Regulating Role of Decision-making Preparation

Status:

Version 2

Abstract

Figures

Introduction

Methods

Participants

Measures

Decision Regret

Decision Conflict

The Preparation of decision-making

Data collection method

Statistical Analysis

Results

Discussion

Conclusions

Declarations

References

Status:

Version 2