Research progress on application of shared decision-making in screening and treatment for patients with colorectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHOU Xin ^1,2 , LIU Yuwei ^1,3 ,  LI Ka ¹

1. West China School of Nursing, Sichuan University / West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan 610213;
3. Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

LI Ka, Email: lika127@126.com

Keywords：

colorectal cancer; shared decision-making; decision-making tools; review

DOI：

10.7507/1007-9424.202507013

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the application of decision-making support tools in the screening and treatment stages of colorectal cancer, as well as the influencing factors for the effective implementation of shared decision-making, in order to provide references for optimizing the comprehensive management model of colorectal cancer, formulating personalized doctor-patient communication strategies, and improving the shared decision-making support system. Methods A systematic search was conducted in Chinese and English databases for relevant literature on the application of shared decision-making in colorectal cancer patients, followed by a summary and analysis. Results Shared decision-making can improve patient satisfaction with decision-making and treatment adherence, as well as enhance the doctor-patient relationship. Decision-making support tools demonstrate good efficacy across all stages of colorectal cancer screening and treatment; however, numerous factors influence their effective implementation, necessitating further optimization based on patient characteristics and clinical circumstances. Conclusion Shared decision-making is an important model for the comprehensive management of colorectal cancer. Future efforts should focus on enhancing healthcare providers' communication skills, developing personalized decision-making tools, and addressing patients' psychological and economic needs to promote the widespread adoption of shared decision-making.

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2.	Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
3.	Selva A, López P, Puig T, et al. Patient experience, satisfaction and shared decision-making in colorectal cancer screening: protocol of the mixed-methods study CyDESA. BMJ Open, 2022, 12(5): e057687. doi: 10.1136/bmjopen-2021-057687.
4.	Herrera DJ, van de Veerdonk W, Talboom S, et al. Shared decision-making tool development for colorectal cancer screening: a co-creative process with general practitioners and underserved people. Public Health, 2025, 242: 236-243.
5.	Zhai H, Lavender C, Li C, et al. Who decides? Shared decision-making among colorectal cancer surgery patients in China. Support Care Cancer, 2020, 28(11): 5353-5361.
6.	Shaker MS, Verdi M. Operationalizing shared decision making in clinical practice. Allergy Asthma Proc, 2024, 45(6): 398-403.
7.	Sepucha KR, Chang Y, Valentine KD, et al. Shared decision-making in colorectal cancer screening for older adults: a secondary analysis of a cluster randomized clinical trial. JAMA Netw Open, 2024, 7(8): e2429645. doi: 10.1001/jamanetworkopen.2024.29645.
8.	Le Minor M, Alpérovitch A, Knill-Jones RP. Applying decision theory to medical decision-making—concept of regret and error of diagnosis. Methods Inf Med, 1982, 21(1): 3-8.
9.	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.
10.	Stevenson FA, Barry CA, Britten N, et al. Doctor-patient communication about drugs: the evidence for shared decision making. Soc Sci Med, 2000, 50(6): 829-840.
11.	Salzburg Global Seminar. Salzburg statement on shared decision making. BMJ, 2011, 342: d1745. doi: 10.1136/bmj.d1745.
12.	Carmona C, Crutwell J, Burnham M, et al. Shared decision-making: summary of NICE guidance. BMJ, 2021, 373: n1430. doi: 10.1136/bmj.n1430.
13.	Park SY, Kim Y, Katapodi MC, et al. Outcomes and effectiveness of decision aids for families affected by hereditary cancer syndromes: a scoping review. Genet Med, 2025, 27(7): 101424. doi: 10.1016/j.gim.2025.101424.
14.	Samusure J, Horisberger D, Diserens C, et al. Information materials for colorectal cancer screening for citizens with low health literacy. Rev Med Suisse, 2022, 18(775): 616-620.
15.	Goldstein KM, Fisher DA, Wu RR, et al. An electronic family health history tool to identify and manage patients at increased risk for colorectal cancer: protocol for a randomized controlled trial. Trials, 2019, 20(1): 576. doi: 10.1186/s13063-019-3659-y.
16.	Sepucha KR, Valentine KD, Atlas SJ, et al. Getting patients back for routine colorectal cancer screening: randomized controlled trial of a shared decision-making intervention. Cancer Med, 2023, 12(3): 3555-3566.
17.	廖謙, 余雨楓, 姚婷, 等. 基于互聯網的決策輔助工具在結直腸癌篩查中應用效果的系統評價. 中國現代醫生, 2024, 62(16): 51-56.
18.	Volk RJ, Linder SK, Lopez-Olivo MA, et al. Patient decision aids for colorectal cancer screening: a systematic review and meta-analysis. Am J Prev Med, 2016, 51(5): 779-791.
19.	李煥煥. 以家庭為中心的遺傳性結直腸癌基因檢測決策輔助工具的構建與應用. 長春: 吉林大學, 2023.
20.	Herrera DJ, van de Veerdonk W, Talboom S, et al. Shared decision-making tool development for colorectal cancer screening: a co-creative process with general practitioners and underserved people. Public Health, 2025, 242: 236-243.
21.	Jiang W, Chen H, Yang L, et al. moreThanANOVA: a user-friendly Shiny/R application for exploring and comparing data with interactive visualization. PLoS One, 2022, 17(7): e0271185. doi: 10.1371/journal.pone.0271185.
22.	Gaetani RS, Ladin K, Abelson JS. Journey through the decades: the evolution in treatment and shared decision making for locally advanced rectal cancer. Cancers (Basel), 2024, 16(16): 2807. doi: 10.3390/cancers16162807.
23.	中華醫學會腫瘤學分會, 國家衛生健康委員會醫政司. 中國結直腸癌診療規范(2023版). 協和醫學雜志, 2023, 14(4): 706-733.
24.	段玉霞, 李珍, 張斯齊, 等. 結直腸癌診療中患者決策輔助工具應用效果的系統評價. 中國全科醫學, 2023, 26(25): 3194-3201.
25.	Wu CC, Wang JH, Chang MC, et al. Shared decision-making and patient decision aids in choosing first-line targeted therapy for metastatic colorectal cancer in Taiwan. J Oncol Pharm Pract, 2022, 28(6): 1293-1302.
26.	Kleppe A, Skrede OJ, De Raedt S, et al. A clinical decision support system optimising adjuvant chemotherapy for colorectal cancers by integrating deep learning and pathological staging markers: a development and validation study. Lancet Oncol, 2022, 23(9): 1221-1232.
27.	Khan A, Sellyn GE, Ali D, et al. Three-dimensional-printed models and shared decision-making: a cluster randomized clinical trial. JAMA Netw Open, 2025, 8(6): e2513187. doi: 10.1001/jamanetworkopen.2025.13187.
28.	Ivatury SJ, Durand MA, Elwyn G. Shared decision-making for rectal cancer treatment: a path forward. Dis Colon Rectum, 2019, 62(12): 1412-1413.
29.	Palmer R, Kite J, Phongsavan P, et al. Age-related differences in men’s preferences and barriers to healthcare: Insights from a national Australian survey. PLoS One, 2025, 20(5): e0323733. doi: 10.1371/journal.pone.0323733.
30.	Gu XF, Xu HF, Liu Y, et al. Involvement in treatment decision-making and self-reported efficacy among patients with advanced colorectal cancer: a nationwide multi-center cross-sectional study. Front Oncol, 2023, 13: 1168078. doi: 10.3389/fonc.2023.1168078.
31.	Hwang S, Lazard AJ, Reffner Collins MK, et al. Exploring the acceptability of text messages to inform and support shared decision-making for colorectal cancer screening: online panel survey. JMIR Cancer, 2023, 9: e40917. doi: 10.2196/40917.
32.	Chang HL, Li FS, Lin CF. Factors influencing implementation of shared medical decision making in patients with cancer. Patient Prefer Adherence, 2019, 13: 1995-2005.
33.	Efverman A, Bergius Axelsson B. Observing the implementation of shared decision-making in routine radiotherapy cancer nursing: an explorative longitudinal questionnaire study. Cancer Nurs, 2021, 44(5): 369-377.
34.	Hernández R, Calderon C, Carmona-Bayonas A, et al. Differences in coping strategies among young adults and the elderly with cancer. Psychogeriatrics, 2019, 19(5): 426-434.
35.	伊若男, 劉偉偉, 劉紅霞, 等. 結直腸癌術后患者無法忍受不確定性對心理痛苦影響的作用路徑分析. 護理學雜志, 2023, 38(17): 95-99.
36.	Leon-Carlyle M, Spiegle G, Schmocker S, et al. Using patient and physician perspectives to develop a shared decision-making framework for colorectal cancer. Implement Sci, 2009, 4: 81. doi: 10.1186/1748-5908-4-81.
37.	季靜芬, 黎萌, 伍雅琴, 等. 結直腸癌患者決策自我效能及智謀對其經濟毒性的影響. 護理管理雜志, 2024, 24(6): 518-522.
38.	Hibino M, Hamashima C, Hirosue M, et al. Comparative effectiveness of decision aids for cancer-screening decision making: an overview of reviews. J Gen Intern Med, 2024, 39(16): 3299-3314.
39.	Bisset CN, Dames N, Oliphant R, et al. Exploring shared surgical decision-making from the patient’s perspective: is the personality of the surgeon important?. Colorectal Dis, 2020, 22(12): 2214-2221.
40.	Zhu X, Squiers L, Madson G, et al. Patient-provider communication and colorectal cancer screening completion using multi-target stool DNA testing. J Cancer Educ, 2025, 40(1): 115-123.
41.	Bos-van den Hoek DW, Smets EMA, Ali R, et al. A blended learning for general practitioners and nurses on skills to support shared decision-making with patients about palliative cancer treatment: A one-group pre-posttest study. Patient Educ Couns, 2023, 112: 107712. doi: 10.1016/j.pec.2023.107712.
42.	Li M, Fu G, Mo W, et al. Analysis of influencing factors and strategies of implementing shared decision-making among patients with gastrointestinal cancer: a systematic review and meta-analysis of qualitative studies. Ann Surg Oncol, 2025, 32(7): 5183-5199.
43.	李夢楠, 顏媛媛, 付廣, 等. 結直腸癌患者醫患共同決策實施的困境分析與應對策略. 中國醫藥導報, 2025, 22(6): 76-79.
44.	劉俊君, 霍增輝. 醫療決策中患者自主決定權的困境、沖突與破解. 中國醫學倫理學, 2024, 37(3): 253-260.
45.	姜倩倩, 裴文鍵, 陳亞楠, 等. 結直腸癌患者家庭照顧者的決策疲勞現狀及影響因素研究. 中國醫藥導報, 2024, 21(22): 102-107.
46.	Blot F, Moumjid N. Shared decision-making: ethical issues. La Revue Du Praticien, 2023, 73(7): 709-712.
47.	陳鳳, 鄭萍, 胡蓉, 等. 結直腸癌患者經濟毒性的研究進展. 實用醫院臨床雜志, 2024, 21(6): 205-208.
48.	Krist AH, Hochheimer CJ, Sabo RT, et al. Patient, clinician, and communication factors associated with colorectal cancer screening. J Am Board Fam Med, 2020, 33(5): 779-784.
49.	Wang Y, Gu Y, Yu H. Correlation between patients’ power distance and their willingness to participate in patients’ safety: a cross-sectional study. J Nurs Manag, 2022, 30(5): 1345-1354.
50.	徐夢亞, 武江華, 王文婷. 結直腸癌病人權力距離對醫患共同決策的影響. 護理研究, 2024, 38(9): 1632-1637.

1. Matsuda T, Fujimoto A, Igarashi Y. Colorectal Cancer: Epidemiology, Risk Factors, and Public Health Strategies. Digestion. 2025, 106(2): 91-99. doi:10.1159/000543921.
2. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
3. Selva A, López P, Puig T, et al. Patient experience, satisfaction and shared decision-making in colorectal cancer screening: protocol of the mixed-methods study CyDESA. BMJ Open, 2022, 12(5): e057687. doi: 10.1136/bmjopen-2021-057687.
4. Herrera DJ, van de Veerdonk W, Talboom S, et al. Shared decision-making tool development for colorectal cancer screening: a co-creative process with general practitioners and underserved people. Public Health, 2025, 242: 236-243.
5. Zhai H, Lavender C, Li C, et al. Who decides? Shared decision-making among colorectal cancer surgery patients in China. Support Care Cancer, 2020, 28(11): 5353-5361.
6. Shaker MS, Verdi M. Operationalizing shared decision making in clinical practice. Allergy Asthma Proc, 2024, 45(6): 398-403.
7. Sepucha KR, Chang Y, Valentine KD, et al. Shared decision-making in colorectal cancer screening for older adults: a secondary analysis of a cluster randomized clinical trial. JAMA Netw Open, 2024, 7(8): e2429645. doi: 10.1001/jamanetworkopen.2024.29645.
8. Le Minor M, Alpérovitch A, Knill-Jones RP. Applying decision theory to medical decision-making—concept of regret and error of diagnosis. Methods Inf Med, 1982, 21(1): 3-8.
9. 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.
10. Stevenson FA, Barry CA, Britten N, et al. Doctor-patient communication about drugs: the evidence for shared decision making. Soc Sci Med, 2000, 50(6): 829-840.
11. Salzburg Global Seminar. Salzburg statement on shared decision making. BMJ, 2011, 342: d1745. doi: 10.1136/bmj.d1745.
12. Carmona C, Crutwell J, Burnham M, et al. Shared decision-making: summary of NICE guidance. BMJ, 2021, 373: n1430. doi: 10.1136/bmj.n1430.
13. Park SY, Kim Y, Katapodi MC, et al. Outcomes and effectiveness of decision aids for families affected by hereditary cancer syndromes: a scoping review. Genet Med, 2025, 27(7): 101424. doi: 10.1016/j.gim.2025.101424.
14. Samusure J, Horisberger D, Diserens C, et al. Information materials for colorectal cancer screening for citizens with low health literacy. Rev Med Suisse, 2022, 18(775): 616-620.
15. Goldstein KM, Fisher DA, Wu RR, et al. An electronic family health history tool to identify and manage patients at increased risk for colorectal cancer: protocol for a randomized controlled trial. Trials, 2019, 20(1): 576. doi: 10.1186/s13063-019-3659-y.
16. Sepucha KR, Valentine KD, Atlas SJ, et al. Getting patients back for routine colorectal cancer screening: randomized controlled trial of a shared decision-making intervention. Cancer Med, 2023, 12(3): 3555-3566.
17. 廖謙, 余雨楓, 姚婷, 等. 基于互聯網的決策輔助工具在結直腸癌篩查中應用效果的系統評價. 中國現代醫生, 2024, 62(16): 51-56.
18. Volk RJ, Linder SK, Lopez-Olivo MA, et al. Patient decision aids for colorectal cancer screening: a systematic review and meta-analysis. Am J Prev Med, 2016, 51(5): 779-791.
19. 李煥煥. 以家庭為中心的遺傳性結直腸癌基因檢測決策輔助工具的構建與應用. 長春: 吉林大學, 2023.
20. Herrera DJ, van de Veerdonk W, Talboom S, et al. Shared decision-making tool development for colorectal cancer screening: a co-creative process with general practitioners and underserved people. Public Health, 2025, 242: 236-243.
21. Jiang W, Chen H, Yang L, et al. moreThanANOVA: a user-friendly Shiny/R application for exploring and comparing data with interactive visualization. PLoS One, 2022, 17(7): e0271185. doi: 10.1371/journal.pone.0271185.
22. Gaetani RS, Ladin K, Abelson JS. Journey through the decades: the evolution in treatment and shared decision making for locally advanced rectal cancer. Cancers (Basel), 2024, 16(16): 2807. doi: 10.3390/cancers16162807.
23. 中華醫學會腫瘤學分會, 國家衛生健康委員會醫政司. 中國結直腸癌診療規范(2023版). 協和醫學雜志, 2023, 14(4): 706-733.
24. 段玉霞, 李珍, 張斯齊, 等. 結直腸癌診療中患者決策輔助工具應用效果的系統評價. 中國全科醫學, 2023, 26(25): 3194-3201.
25. Wu CC, Wang JH, Chang MC, et al. Shared decision-making and patient decision aids in choosing first-line targeted therapy for metastatic colorectal cancer in Taiwan. J Oncol Pharm Pract, 2022, 28(6): 1293-1302.
26. Kleppe A, Skrede OJ, De Raedt S, et al. A clinical decision support system optimising adjuvant chemotherapy for colorectal cancers by integrating deep learning and pathological staging markers: a development and validation study. Lancet Oncol, 2022, 23(9): 1221-1232.
27. Khan A, Sellyn GE, Ali D, et al. Three-dimensional-printed models and shared decision-making: a cluster randomized clinical trial. JAMA Netw Open, 2025, 8(6): e2513187. doi: 10.1001/jamanetworkopen.2025.13187.
28. Ivatury SJ, Durand MA, Elwyn G. Shared decision-making for rectal cancer treatment: a path forward. Dis Colon Rectum, 2019, 62(12): 1412-1413.
29. Palmer R, Kite J, Phongsavan P, et al. Age-related differences in men’s preferences and barriers to healthcare: Insights from a national Australian survey. PLoS One, 2025, 20(5): e0323733. doi: 10.1371/journal.pone.0323733.
30. Gu XF, Xu HF, Liu Y, et al. Involvement in treatment decision-making and self-reported efficacy among patients with advanced colorectal cancer: a nationwide multi-center cross-sectional study. Front Oncol, 2023, 13: 1168078. doi: 10.3389/fonc.2023.1168078.
31. Hwang S, Lazard AJ, Reffner Collins MK, et al. Exploring the acceptability of text messages to inform and support shared decision-making for colorectal cancer screening: online panel survey. JMIR Cancer, 2023, 9: e40917. doi: 10.2196/40917.
32. Chang HL, Li FS, Lin CF. Factors influencing implementation of shared medical decision making in patients with cancer. Patient Prefer Adherence, 2019, 13: 1995-2005.
33. Efverman A, Bergius Axelsson B. Observing the implementation of shared decision-making in routine radiotherapy cancer nursing: an explorative longitudinal questionnaire study. Cancer Nurs, 2021, 44(5): 369-377.
34. Hernández R, Calderon C, Carmona-Bayonas A, et al. Differences in coping strategies among young adults and the elderly with cancer. Psychogeriatrics, 2019, 19(5): 426-434.
35. 伊若男, 劉偉偉, 劉紅霞, 等. 結直腸癌術后患者無法忍受不確定性對心理痛苦影響的作用路徑分析. 護理學雜志, 2023, 38(17): 95-99.
36. Leon-Carlyle M, Spiegle G, Schmocker S, et al. Using patient and physician perspectives to develop a shared decision-making framework for colorectal cancer. Implement Sci, 2009, 4: 81. doi: 10.1186/1748-5908-4-81.
37. 季靜芬, 黎萌, 伍雅琴, 等. 結直腸癌患者決策自我效能及智謀對其經濟毒性的影響. 護理管理雜志, 2024, 24(6): 518-522.
38. Hibino M, Hamashima C, Hirosue M, et al. Comparative effectiveness of decision aids for cancer-screening decision making: an overview of reviews. J Gen Intern Med, 2024, 39(16): 3299-3314.
39. Bisset CN, Dames N, Oliphant R, et al. Exploring shared surgical decision-making from the patient’s perspective: is the personality of the surgeon important?. Colorectal Dis, 2020, 22(12): 2214-2221.
40. Zhu X, Squiers L, Madson G, et al. Patient-provider communication and colorectal cancer screening completion using multi-target stool DNA testing. J Cancer Educ, 2025, 40(1): 115-123.
41. Bos-van den Hoek DW, Smets EMA, Ali R, et al. A blended learning for general practitioners and nurses on skills to support shared decision-making with patients about palliative cancer treatment: A one-group pre-posttest study. Patient Educ Couns, 2023, 112: 107712. doi: 10.1016/j.pec.2023.107712.
42. Li M, Fu G, Mo W, et al. Analysis of influencing factors and strategies of implementing shared decision-making among patients with gastrointestinal cancer: a systematic review and meta-analysis of qualitative studies. Ann Surg Oncol, 2025, 32(7): 5183-5199.
43. 李夢楠, 顏媛媛, 付廣, 等. 結直腸癌患者醫患共同決策實施的困境分析與應對策略. 中國醫藥導報, 2025, 22(6): 76-79.
44. 劉俊君, 霍增輝. 醫療決策中患者自主決定權的困境、沖突與破解. 中國醫學倫理學, 2024, 37(3): 253-260.
45. 姜倩倩, 裴文鍵, 陳亞楠, 等. 結直腸癌患者家庭照顧者的決策疲勞現狀及影響因素研究. 中國醫藥導報, 2024, 21(22): 102-107.
46. Blot F, Moumjid N. Shared decision-making: ethical issues. La Revue Du Praticien, 2023, 73(7): 709-712.
47. 陳鳳, 鄭萍, 胡蓉, 等. 結直腸癌患者經濟毒性的研究進展. 實用醫院臨床雜志, 2024, 21(6): 205-208.
48. Krist AH, Hochheimer CJ, Sabo RT, et al. Patient, clinician, and communication factors associated with colorectal cancer screening. J Am Board Fam Med, 2020, 33(5): 779-784.
49. Wang Y, Gu Y, Yu H. Correlation between patients’ power distance and their willingness to participate in patients’ safety: a cross-sectional study. J Nurs Manag, 2022, 30(5): 1345-1354.
50. 徐夢亞, 武江華, 王文婷. 結直腸癌病人權力距離對醫患共同決策的影響. 護理研究, 2024, 38(9): 1632-1637.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesResearch progress on application of shared decision-making in screening and treatment for patients with colorectal cancer

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