To date, the interplay between decision regret, decision conflict and decision preparation has not been indirectly tested via a mediation model. Several studies have found that decision regret was related with decision conflict, but there are no research to exam the possible mechanism for this correlation. We found decision regret BC patients more negatively engage in decision progress, and this was related with less decision preparation and developed more decision conflict.
The results of this study show that the postoperative decision regret score of 320 breast cancer patients was 34.28(SD=20.18),which is higher than the decision regret level in Chinese American women with BC[18]. The reasons could be that the inclusion population live in different countries and share a different medical service. In China, BC patients play a passion role in decision progress, and they didn’t have enough time to do a preferred decision because of the heavy patient’s burden[7], In USA, the decision regret is associated with financial barriers and consultation limitation by language. Our finding is similar with several investigation [9,23]which are carried on BC patients aiming to exam the level of decision regret after surgery. With the spread of Shared decision making, the physicians encourage patients to participant in treatment decision aiming to meet patients' needs and preference[24].Most Chinese patients still prefer survival rate rather than quality of life. Because of traditional culture and patients’ perception, the mastectomies is the best treatment in economic cost and survival[25]. Meanwhile, one research found that age affects decision regret among breast cancer patients, especially among patients after total mastectomy, such that younger patients experienced more decision regret[9]. The high incidence of young patients’ decision regrets is related to fertility, and the reason why the results of this study are inconsistent with the results of Japanese research may be due to the fact that 83.75% of the subjects included in the present study were older than 40 years old and had fewer fertility concerns[9].In addition, the types of surgical procedures and different occupational types affect patients' decision regret. Because of women who engage in contract or part-time work have a lower probability of experiencing decision regret than women with working full-time. A previous research in German[26] found that patients were more inclined to consult doctors and think their doctors would show more sympathy. In our study,55% BC patients do surgical options with family. The reasons is that BC patients build a poor communication with clinicians and have no time to discuss the type of cancer, its treatment, and a person's preferences and perceptions of treatment choices[27-30]. 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.
In this study, decision-making preparation had a regulatory effect between decision conflicts and decision regrets. The prerequisite for patients to participant 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[32]. Decision-making preparation manifests as participation competence in decision-making process with their doctor[22]. In China, caner patients are highly motivated to participate in treatment decision, but more than 40% patients depend on physicians to make treatment decision and 62.8% patients make decision with family actually[32]. One explanation is traditional Chinese cultural centered on family since ancient times.In addition, Ottawa's decision support theory based on decision conflict theory and social support theory[16] have determined that participation competence is a prerequisite for the decision-making process. Decision-making is a complex processes, and there are many influenced factor such as social statistics and clinical characteristics, expectations, values, decision conflicts, social support, decision-making roles, and personal resources[24]. When BC patients actively participate in treatment decision,they will seek the amount of information about available options and reduce decision regret[33].However, this study found the influence of decision conflicts on decision regrets increases with decision-making preparation increases.One possible explanation is that the source of information mainly relies on the internet in Chinese medical environment.Network information is not strictly screened and often causes greater decision conflicts in decision-making. Thus, medical staff shouldn’t blindly pursue the increase of patient participation and should provided specialization information support for breast cancer patients to increase decision preparation and eliminate decision conflict.
Our finding also has an important clinical implication for relieve the level of decision regret.We found that greater decision conflict predicted a higher level of decision regret, and similar result also found in a previous study[34]. The reason is that different breast surgical operation have different risks and benefits.Because of there are no adequate information support to introduce costs, surgical sites, potential complications , and femininity with post-operation.These results are similar with the share decision-making model[23, 35],which determine the importance of patients’ information needs before decision-making, and encourage patients actively participating in decision-making experience less regret than women who delegate treatment decision-making to their physicians. A research shown that breast cancer treatment was widely selective and active. Because of various medical advice may make patients feel overwhelmed and they have a difficulty to understanding medical information [36, 37].A study in Australia showed that the Breast Reconstruction Decision Support Program significantly reduced decision conflicts and increased satisfaction with information [38]. The overall cost of breast reconstruction decision support programs was less than that of other medical interventions. This suggests that in the process of intervention, we cannot blindly pursue the increase of patient participation and, more importantly, must improve patients' understanding during the process of assisting decision-making in order to improve interventions. For Chinese American women, providers need to develop decision support interventions to support breast cancer patients in making high-quality decisions, but these interventions must also identify established socio-demographic factors[39]. Meanwhile,our prior study found decision aids also reduce the level of decision regret by guiding decision-making and clarifying value preference[ 40]. Future studies should focus on the impact of caregivers on decision-making with breast cancer patients.
Limitations and Future Direction
This study investigated t the regulatory role of decision-making preparation between decision conflicts and decision regrets. However, this study also had several limitations. On the one hand, this study utilized a cross-sectional design and it is not possible to infer a causal relationship. Further research should focus on qualitative study to deeply mini the relationship between decision conflict and decision regret. On the other hand,, this study only collected questionnaires in one hospital in which participants were recruited from an cancer institute in northern part of China. thus.more patients from various parts of the country make the research object more diverse and extensive and facilitate national comparison in future research. Lastly, there were few variables included in this study. Further research should focus on testing what other influenced factors between decision conflict and decision regret.