Predictors of shared decision-making in patients with recurrent and metastatic nasopharyngeal carcinoma: An observational structural equation modeling approach

Abstract

Purpose

This investigation examines the interrelationships between SDM and key behavioral factors—decision-making attitude, self-efficacy, nurse-patient trust, and intention—among Chinese r/m NPC patients through structural equation modeling, guided by the Theory of Planned Behavior.

Methods

A cross-sectional investigation following STROBE guidelines. Through convenience sampling, 301 r/m NPC patients were enrolled from a Southern Chinese tertiary cancer center between November 2023 and June 2024. Participants completed comprehensive assessments including demographic data, the Decision Self-Efficacy Scale, Cancer Patients' Decision-Making Regarding Treatment Scale, Nurse-Patient Trust Scale, and Expectation of Involvement in Medical Decision-Making Scale.

Results

The mean score of SDM among patients with r/m NPC was 18.25 ± 6.29, indicating a low-middle level of SDM. Older age (β = 3.179) contributed to the low SDM level. The results of the structural equation model show that decision-making attitude (β = 0.254) and decision-making intention (β = −0.740) have direct effects on SDM. Furthermore, decision-making attitude (β = −0.453) and decision-making self-efficacy (β = 0.430) can indirectly influence SDM through the decision-making intention.

Conclusion

Healthcare professionals could utilize these pathway-specific findings to enhance shared decision-making implementation. Given the low-middle participation level, especially among elderly patients, healthcare providers should prioritize strategies that strengthen decision-making intention and foster positive participation attitudes. Future interventions should be tailored based on these identified pathways to effectively promote shared decision-making in clinical practice.