研究背景：当前癌症频发且呈年轻化趋势，癌症治疗方案多种多样，让患者难以决策。共同决策模式作为在国外应用比较广泛的先进临床决策方式，可以帮助医患群体做出达成共识的决策，本文选择癌症患者作为研究对象，探究共同决策SDM-Q指标体系的改进方向以及共同决策模式的发展需要改进的方向。研究目的：探究调查对象所在医院癌症患者参与共同决策的现状以及影响因素，通过DANP法探究共同决策问卷（SDM-Q版）的指标间相互影响关系以及权重，从而确定共同决策模式的关键因素，通过IPA法探究对共同决策模式进行改进的方向。研究方法：采用问卷调查的方法对研究所在医院癌症相关科室医生和患者进行问卷调查，使用的是汉化版的国际通用问卷（SDM-Q），通过DANP和IPA的方法探究对该模式进行改进的建议。研究结果：（1）医生群体共同决策得分为78.33分，患者群体共同决策得分为69.17分；不同年龄、性别和教育程度的癌症患者群体参与共同决策的程度有显著性差异；医生群体没有显著性差异。（2）通过DANP方法学确定的患者版SDM-Q问卷中原因度最高的指标为指标2、指标4和指标3，中心度最高的为指标5、指标6和指标8；医生版SDM-Q问卷中原因度最高的指标为指标9、指标5和指标3，中心度最高的为指标5、指标4和指标3；通过DANP方法学计算患者版指标体系权重大小排名为指标5>指标6>指标7>指标8>指标3>指标4>指标9>指标1>指标2；通过DANP方法学计算医生版指标体系权重大小排名为指标2>指标6>指标1>指标5>指标3>指标7>指标4>指标8>指标9。医患双方在共同决策模式指标体系的相互影响关系和权重存在差异。（3）通过IPA分析方法确定患者版SDM-Q指标体系需要着重改善的指标有指标5、指标6和指标7；通过IPA分析方法确定医生版SDM-Q指标体系需要着重改善的指标有指标4，指标5和指标6；综合S确定的DM-Q指标体系需要着重改善的指标有指标7、指标5和指标6和指标4。医患之间在IPA结果上存在差异。研究结论：浙江省某三甲医院开展的共同决策模式有待改进，通过DANP和IPA方法学探究出需要进行改进的指标是指标5、指标6和指标7。另外，医院管理及卫生行政管理方面要多举并用，促进共同决策模式的推广与应用。
Research Background: Currently, cancer occurs frequently and tends to be younger, and various cancer treatment options make it difficult for patients to make decisions.As an advanced clinical decision-making method widely used abroad, joint decision making model can help doctor-patient groups to make consensus decisions. This paper chooses cancer patients as the research object to explore the direction of improvement of the SDM-Q index system of joint decision making and the direction that needs to be improved in the development of joint decision making model.Research Objectives: To explore the status quo and influencing factors of the participation of cancer patients in joint decision making in the hospitals where the respondents worked, explore the interaction relationship and weight among indicators of the joint decision making questionnaire (SDM-Q version) through DANP method, so as to determine the key factors of the joint decision making model, and explore the direction of improvement of the joint decision making model through IPA method.Research Methods: Questionnaire was used to survey doctors and patients in cancer-related departments of the hospital where the study was conducted. The Chinese version of SDM-Q was used. Suggestions for improvement of this model were explored by means of DANP and IPA.Results: （1）The score of doctors' shared decision-making was 78.33, and the score of patients' shared decision-making was 69.17.There were significant differences in the degree of participation of cancer patients with different ages, genders and education levels in joint decision making.There was no significant difference among doctors.（2）In the patient version SDM-Q questionnaire determined by the DANP methodology, the indicators with the highest degree of cause were indicator 2, 4 and 3, and the indicators with the highest degree of centrality were indicator 5, 6 and 8.In the SDM-Q Questionnaire for Doctors, the indexes with the highest degree of cause were indicator 9, 5 and 3, and the indexes with the highest degree of centrality were indicators 5, 4 and 3.Patients through the calculation of DANP methodology version of the index system of size to the weight of Indicator 5 >Indicator 6 >Indicator >7 Indicator 8 >Indicator 3 >Indicator 4 >Indicator 9 >Indicator 1 >Indicator 2;According to the DANP method, the weights of the index system for doctors were ranked as Indicator 2 >Indicator 6 >Indicator 1 >Indicator 5 >Indicator 3 >Indicator 7 >Indicator 4 >Indicator 8 >Indicator 9. There are differences in the mutual influence relationship and weight of the index system of joint decision making model between doctors and patients.（3）According to IPA analysis method, the indicators that need to be improved in the patient version of SDM-Q index system include indicator 5, 6 and 7.According to IPA analysis method, the SDM-Q index system for doctors should focus on improving indicator 4, in 5 and 6.The indicators that need to be improved in the DM-Q index system determined by comprehensive S include indicator 7, 5, 6 and 4. There are differences in IPA outcomes between doctors and patients.Conclusion: TThe model of shared decision-making in a third class A hospital in Zhejiang Province needs to be improved.The indicators that need to be optimized are indicator 5, 6 and 7, mainly explored through the methods of DANP and IPA.In addition, hospital management and health administration should be combined to promote the promotion and application of the joint decision model.
