Effect of shared decision-making intervention on treatment expectation deviation and decision conflict in patients with lung cancer and mediastinal tumors: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Junchen ¹ , CHEN Weihao ¹ , YIN Yuanyuan ² , ZHANG Jie ² , LI Kaidi ² , MA Lin ² , LI Yuanyuan ³ ,  SHEN Cheng ²

1. West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610044, P. R. China;

Corresponding?author：

SHEN Cheng, Email: shencheng568_hx@163.com

Keywords：

Lung cancer; mediastinal tumor; shared decision-making; treatment expectations; decision conflict; patient satisfaction; postoperative complications; personalized diagnosis and treatment

DOI：

10.7507/1007-4848.202603043

Video：

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Objective To investigate the impact of shared decision-making (SDM) intervention on treatment expectations, decisional conflict, and satisfaction in patients with lung cancer and mediastinal tumors, aiming to provide a basis for optimizing personalized diagnosis and treatment models for oncology patients. Methods Patients with lung cancer and mediastinal tumors who met the inclusion criteria, admitted by a single medical team in the Department of Thoracic Surgery, West China Hospital, Sichuan University, from November 2024 to May 2025, were randomly assigned to either a SDM group or a control group using a random number table method. The control group received conventional diagnostic and treatment interventions, while the SDM group received SDM-assisted interventions in addition to the conventional care. Baseline characteristics, treatment expectations, decisional conflict, and satisfaction were compared between the two groups. Results A total of 137 patients were included (69 patients in the SDM group, 68 patients in the control group). In the SDM group, there were 30 males and 39 females, with a mean age of (53.17±15.13) years. In the control group, there were 22 males and 46 females, with a mean age of (53.19±15.91) years. After intervention, the change score for treatment expectations in the SDM group was significantly lower than that in the control group [–9.0 (–9.0, –8.0) points vs. –2.0 (–3.0, –2.0) points, P<0.001]. The change score for decisional conflict in the SDM group was also significantly lower than that in the control group [–21.0 (–29.0, –12.0) points vs. –4.5 (–14.5, 1.0) points, P<0.001]. However, there was no statistically significant difference in satisfaction between the two groups [SDM group: 10.0 (10.0, 10.0) points vs. control group: 10.0 (10.0, 10.0) points, P=0.552]. Conclusion SDM intervention can effectively reduce the deviation in treatment expectations and decisional conflict in patients with lung cancer and mediastinal tumors. It holds important clinical value for enhancing patient engagement in care and optimizing personalized diagnosis and treatment processes.

1.	蔡林, 朱稱心, 袁佳妮, 等. 中國和全球早發性肺癌的疾病負擔及相關風險因素分析. 協和醫學雜志, 2025, 16(4): 1047-1056.Cai L, Zhu CX, Yuan JN, et al. Disease burden and associated risk factors of early-onset lung cancer in China and worldwide. Med J Peking Union Med Coll Hosp, 2025, 16(4): 1047-1056.
2.	張一丁, 張銳. 醫患雙方對疾病治療決策的考量. 醫學與哲學, 2025, 46(13): 23-26.Zhang YD, Zhang R. Considerations in shared decision-making between physicians and patients in disease treatment. Med Philos, 2025, 46(13): 23-26.
3.	劉乙君, 李彥, 劉敏, 等. 醫患共享決策輔助系統在社區 2 型糖尿病管理中的應用效果. 護理研究, 2023, 37(15): 2805-2809.Liu YJ, Li Y, Liu M, et al. Application effect of shared decision making aid system in the management of type 2 diabetesmellitus patients in the communities. Chin Nurs Res, 2023, 37(15): 2805-2809.
4.	S?ndergaard SR, Bechmann T, Maae E, et al. Shared decision-making with breast cancer patients - does it work? Results of the cluster-randomized, multicenter DBCG RT SDM trial. Radiother Oncol, 2024, 193: 110115.
5.	Vriese L, Knottnerus B, Groenveld N, et al. Shared decision-making with patients with limited health literacy - experiences and needs of GPs regarding values clarification. Scand J Prim Health Care, 2026, 44(1): 1-17.
6.	王忠照, 唐昊. 《中華醫學會肺癌臨床診療指南 (2024 版)》更新要點解讀. 海軍軍醫大學學報, 2025, 46(1): 17-23.Wang ZZ, Tang H. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2024 edition): an interpretation of updated points. Acad J Naval Med Univ, 2025, 46(1): 17-23.
7.	李學靖, 孟美琪, 陳思涵, 等. 跨文化視角下我國醫患共同決策的研究進展. 中國護理管理, 2024, 24(6): 956-960.Li XJ, Meng MQ, Chen SH, et al. Research progress on shared decision-making in healthcare from a cross-cultural perspective in China. Chin Nurs Manage, 2024, 24(6): 956-960.
8.	Villalobos M, Uns?ld L, Deis N, et al. The Heidelberg Decision Aid for Patients With Lung Cancer (HELP)—findings of a randomized controlled trial. Dtsch Arztebl Int, 2024, 121(26): 861-867.
9.	Hao YX, Liu ZY, Riter RN, et al. Advancing patient-centered shared decision-making with AI systems for older adult cancer patients. Proceedings of the 2024 CHI Conference on Human Factors in Computing Systems, 2024.
10.	趙鐵夫, 王娜, 彭潔, 等. 醫患共同決策對患者家屬診療期望值及滿意度的影響. 醫學與哲學, 2024, 45(10): 25-27.Zhao TF, Wang N, Peng J, et al. The impact of shared decision-making on patient family members' treatment expectations and satisfaction. Med Philos, 2024, 45(10): 25-27.
11.	喬慧宏, 張浜, 張利珍, 等. SDM 輔助對先心病手術患兒父母決策困境、決策沖突及疾病不確定感的影響. 黑龍江醫藥科學, 2024, 47(2): 103-104.Qiao HH, Zhang B, Zhang LZ, et al. Influence of SDM assistance on decision-making difficulties, decision conflict and disease uncertainty of parents of children with congenital heart disease undergoing surgery. Heilongjiang Med Pharm, 2024, 47(2): 103-104.
12.	尹君, 王權, 余虎, 等. 患者滿意度研究文獻綜述. 中醫藥管理雜志, 2024, 32(10): 5-7.Yin J, Wang Q, Yu H, et al. Literature review of patient satisfaction research. J Tradit Chin Med Manage, 2024, 32(10): 5-7.
13.	Busnel Y, Légaré F, Moumjid N, et al. Shared decision making among patients with chronic conditions in France: a cross-sectional survey in the ComPaRe E-Cohort. Med Decis Making, 2026, 46(4): 461-470.
14.	冉琴, 張宸韜, 傅燚, 等. 醫患共同決策模式對精神分裂癥患者長效針劑治療接受程度的影響. 同濟大學學報(醫學版), 2022, 43(4): 572-578.Ran Q, Zhang CT, Fu Y, et al. The influence of shared decision-making on the acceptance oflong-acting injections in patients with schizophrenia. J Tongji Univ Med Sci, 2022, 43(4): 572-578.
15.	陳偉皓, 張孟尼, 沈誠. 患者報告結局和醫患共同決策在胸外科臨床中的應用. 中國肺癌雜志, 2024, 27(10): 792-798.Chen WH, Zhang MN, Shen C. Application of patient-reported outcomes and shared decision-makingin thoracic surgery. Chin J Lung Cancer, 2024, 27(10): 792-798.
16.	Jeon JH, Higgins MG, Durden J, et al. Attitudes and perspectives on shared decision making among breast surgical oncologists: a qualitative study. Ann Surg Oncol, 2026. Epub ahead of print.
17.	Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med, 1997, 44(5): 681-692.
18.	Kolly J, Lelorain S, Penel N, et al. Cancer progression and shared decision-making: crossed. Patient Educ Couns, 2026, 145: 109464.
19.	Alkhaldi R, Pathak N, Mintsopoulos V, et al. Implementing decision aid use and shared decision-making in breast cancer screening: a scoping review. Patient Educ Couns, 2026, 144: 109443.
20.	Zisman-Ilani Y, Rhee CM, Ammary FA, et al. Shared decision-making and decision aids in the management of kidney disease and renal replacement treatment options. Curr Opin Nephrol Hypertens, 2026, 35(1): 13-20.
21.	Plaisance A, Turgeon J, Souza LG, et al. Exploring the impact of a context-adapted decision aid and online training about shared decision making about goals of care with elderly patients in the intensive care unit: a mixed-methods study. Patient, 2026, 19(1): 145-160.
22.	Wijngaarde RO, Faisal A, Nizar M, et al. Shared decision-making between pediatricians and children (or their parents) with chronic disease in the Maldives: a multi-center exploratory study. Patient Educ Couns, 2026, 142: 109342.
23.	Fischer L, Wollny R, Schewe LV, et al. Integrating shared decision making and decision support tools into clinical practice guidelines: what does it take? a qualitative study. Med Decis Making, 2026, 46(1): 60-75.
24.	Wang X, Yuan K, Cao X, et al. Research evolution and frontiers of shared decision-making in pediatrics: a bibliometric analysis based on CiteSpace. Transl Pediatr, 2025, 14(12): 3361-3374.
25.	Knudsen BM, S?ndergaard SR, Carley M, et al. Effects of patient decision aids used pre-consult or in-consult on patient-clinician communication - secondary analysis of a systematic review with meta-analysis. BMC Med Inform Decis Mak, 2025, 26(1): 17.
26.	Volk RJ, Maki KG, Rogova A, et al. The counseling and shared decision-making visit for lung cancer screening: a thematic analysis of public comments to the Centers for Medicare & Medicaid Services during the 2021-2022 National Coverage Analysis process. Chest, 2026, 169(5): 1402-1414.
27.	Lorenzini G, Arbelaez Ossa L, Shaw D, et al. Artificial Intelligence and the doctor-patient relationship expanding the paradigm of shared decision making. Bioethics, 2025. PMID: 41385350.
28.	Arterburn DE, Wellman R, Courcoulas A, et al. Enhancing shared decision-making in metabolic and bariatric surgery: a multi-system implementation and evaluation. Obes Sci Pract, 2025, 11(6): e70091.
29.	Morgan TL, Hudek N, Carroll K, et al. Patient engagement and shared decision-making in trial recruitment intervention studies: a systematic review. Res Involv Engagem, 2025, 11(1): 142.
30.	房志敏, 緱一鳴. 患者參與醫患共同決策的思考. 醫學與哲學, 2024, 45(10): 20-24.Fang ZM, Gou YM. Reflection on patient involvement in shared decision-making. Med Philos, 2024, 45(10): 20-24.

1. 蔡林, 朱稱心, 袁佳妮, 等. 中國和全球早發性肺癌的疾病負擔及相關風險因素分析. 協和醫學雜志, 2025, 16(4): 1047-1056.Cai L, Zhu CX, Yuan JN, et al. Disease burden and associated risk factors of early-onset lung cancer in China and worldwide. Med J Peking Union Med Coll Hosp, 2025, 16(4): 1047-1056.
2. 張一丁, 張銳. 醫患雙方對疾病治療決策的考量. 醫學與哲學, 2025, 46(13): 23-26.Zhang YD, Zhang R. Considerations in shared decision-making between physicians and patients in disease treatment. Med Philos, 2025, 46(13): 23-26.
3. 劉乙君, 李彥, 劉敏, 等. 醫患共享決策輔助系統在社區 2 型糖尿病管理中的應用效果. 護理研究, 2023, 37(15): 2805-2809.Liu YJ, Li Y, Liu M, et al. Application effect of shared decision making aid system in the management of type 2 diabetesmellitus patients in the communities. Chin Nurs Res, 2023, 37(15): 2805-2809.
4. S?ndergaard SR, Bechmann T, Maae E, et al. Shared decision-making with breast cancer patients - does it work? Results of the cluster-randomized, multicenter DBCG RT SDM trial. Radiother Oncol, 2024, 193: 110115.
5. Vriese L, Knottnerus B, Groenveld N, et al. Shared decision-making with patients with limited health literacy - experiences and needs of GPs regarding values clarification. Scand J Prim Health Care, 2026, 44(1): 1-17.
6. 王忠照, 唐昊. 《中華醫學會肺癌臨床診療指南 (2024 版)》更新要點解讀. 海軍軍醫大學學報, 2025, 46(1): 17-23.Wang ZZ, Tang H. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2024 edition): an interpretation of updated points. Acad J Naval Med Univ, 2025, 46(1): 17-23.
7. 李學靖, 孟美琪, 陳思涵, 等. 跨文化視角下我國醫患共同決策的研究進展. 中國護理管理, 2024, 24(6): 956-960.Li XJ, Meng MQ, Chen SH, et al. Research progress on shared decision-making in healthcare from a cross-cultural perspective in China. Chin Nurs Manage, 2024, 24(6): 956-960.
8. Villalobos M, Uns?ld L, Deis N, et al. The Heidelberg Decision Aid for Patients With Lung Cancer (HELP)—findings of a randomized controlled trial. Dtsch Arztebl Int, 2024, 121(26): 861-867.
9. Hao YX, Liu ZY, Riter RN, et al. Advancing patient-centered shared decision-making with AI systems for older adult cancer patients. Proceedings of the 2024 CHI Conference on Human Factors in Computing Systems, 2024.
10. 趙鐵夫, 王娜, 彭潔, 等. 醫患共同決策對患者家屬診療期望值及滿意度的影響. 醫學與哲學, 2024, 45(10): 25-27.Zhao TF, Wang N, Peng J, et al. The impact of shared decision-making on patient family members' treatment expectations and satisfaction. Med Philos, 2024, 45(10): 25-27.
11. 喬慧宏, 張浜, 張利珍, 等. SDM 輔助對先心病手術患兒父母決策困境、決策沖突及疾病不確定感的影響. 黑龍江醫藥科學, 2024, 47(2): 103-104.Qiao HH, Zhang B, Zhang LZ, et al. Influence of SDM assistance on decision-making difficulties, decision conflict and disease uncertainty of parents of children with congenital heart disease undergoing surgery. Heilongjiang Med Pharm, 2024, 47(2): 103-104.
12. 尹君, 王權, 余虎, 等. 患者滿意度研究文獻綜述. 中醫藥管理雜志, 2024, 32(10): 5-7.Yin J, Wang Q, Yu H, et al. Literature review of patient satisfaction research. J Tradit Chin Med Manage, 2024, 32(10): 5-7.
13. Busnel Y, Légaré F, Moumjid N, et al. Shared decision making among patients with chronic conditions in France: a cross-sectional survey in the ComPaRe E-Cohort. Med Decis Making, 2026, 46(4): 461-470.
14. 冉琴, 張宸韜, 傅燚, 等. 醫患共同決策模式對精神分裂癥患者長效針劑治療接受程度的影響. 同濟大學學報(醫學版), 2022, 43(4): 572-578.Ran Q, Zhang CT, Fu Y, et al. The influence of shared decision-making on the acceptance oflong-acting injections in patients with schizophrenia. J Tongji Univ Med Sci, 2022, 43(4): 572-578.
15. 陳偉皓, 張孟尼, 沈誠. 患者報告結局和醫患共同決策在胸外科臨床中的應用. 中國肺癌雜志, 2024, 27(10): 792-798.Chen WH, Zhang MN, Shen C. Application of patient-reported outcomes and shared decision-makingin thoracic surgery. Chin J Lung Cancer, 2024, 27(10): 792-798.
16. Jeon JH, Higgins MG, Durden J, et al. Attitudes and perspectives on shared decision making among breast surgical oncologists: a qualitative study. Ann Surg Oncol, 2026. Epub ahead of print.
17. Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med, 1997, 44(5): 681-692.
18. Kolly J, Lelorain S, Penel N, et al. Cancer progression and shared decision-making: crossed. Patient Educ Couns, 2026, 145: 109464.
19. Alkhaldi R, Pathak N, Mintsopoulos V, et al. Implementing decision aid use and shared decision-making in breast cancer screening: a scoping review. Patient Educ Couns, 2026, 144: 109443.
20. Zisman-Ilani Y, Rhee CM, Ammary FA, et al. Shared decision-making and decision aids in the management of kidney disease and renal replacement treatment options. Curr Opin Nephrol Hypertens, 2026, 35(1): 13-20.
21. Plaisance A, Turgeon J, Souza LG, et al. Exploring the impact of a context-adapted decision aid and online training about shared decision making about goals of care with elderly patients in the intensive care unit: a mixed-methods study. Patient, 2026, 19(1): 145-160.
22. Wijngaarde RO, Faisal A, Nizar M, et al. Shared decision-making between pediatricians and children (or their parents) with chronic disease in the Maldives: a multi-center exploratory study. Patient Educ Couns, 2026, 142: 109342.
23. Fischer L, Wollny R, Schewe LV, et al. Integrating shared decision making and decision support tools into clinical practice guidelines: what does it take? a qualitative study. Med Decis Making, 2026, 46(1): 60-75.
24. Wang X, Yuan K, Cao X, et al. Research evolution and frontiers of shared decision-making in pediatrics: a bibliometric analysis based on CiteSpace. Transl Pediatr, 2025, 14(12): 3361-3374.
25. Knudsen BM, S?ndergaard SR, Carley M, et al. Effects of patient decision aids used pre-consult or in-consult on patient-clinician communication - secondary analysis of a systematic review with meta-analysis. BMC Med Inform Decis Mak, 2025, 26(1): 17.
26. Volk RJ, Maki KG, Rogova A, et al. The counseling and shared decision-making visit for lung cancer screening: a thematic analysis of public comments to the Centers for Medicare & Medicaid Services during the 2021-2022 National Coverage Analysis process. Chest, 2026, 169(5): 1402-1414.
27. Lorenzini G, Arbelaez Ossa L, Shaw D, et al. Artificial Intelligence and the doctor-patient relationship expanding the paradigm of shared decision making. Bioethics, 2025. PMID: 41385350.
28. Arterburn DE, Wellman R, Courcoulas A, et al. Enhancing shared decision-making in metabolic and bariatric surgery: a multi-system implementation and evaluation. Obes Sci Pract, 2025, 11(6): e70091.
29. Morgan TL, Hudek N, Carroll K, et al. Patient engagement and shared decision-making in trial recruitment intervention studies: a systematic review. Res Involv Engagem, 2025, 11(1): 142.
30. 房志敏, 緱一鳴. 患者參與醫患共同決策的思考. 醫學與哲學, 2024, 45(10): 20-24.Fang ZM, Gou YM. Reflection on patient involvement in shared decision-making. Med Philos, 2024, 45(10): 20-24.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesEffect of shared decision-making intervention on treatment expectation deviation and decision conflict in patients with lung cancer and mediastinal tumors: A randomized controlled trial

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