Article(id=1322168059327004969, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322167989802217791, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.04.024, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1733241600000, receivedDateStr=2024-12-04, revisedDate=1769443200000, revisedDateStr=2026-01-27, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159030037, onlineDateStr=2026-10-28, pubDate=1771948800000, pubDateStr=2026-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159030037, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159030037, creator=13701087609, updateTime=1793159030037, updator=13701087609, issue=Issue{id=1322167989802217791, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='4', pageStart='529', pageEnd='704', issueExtLink='null', onlineDate='null', pubDate='1771948800000', pubDateStr='2026-02-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159013461, creator='13701087609', updateTime=1793159013461, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=684, endPage=688, ext={EN=ArticleExt(id=1322168060270723370, articleId=1322168059327004969, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Research progress on the decisional conflict of cancer screening for first-degree relatives of cancer patients, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

This article reviewed the current situation of the decisional conflict in cancer screening for first-degree relatives of cancer patients.It summarized the influence of factors such as individuals,medical care,social support and health literacy,disease cognition and risk perception on the dilemma of screening decision-making.Furthermore,it proposed potential strategies to address these challenges,with the aim of guiding healthcare professionals in developing personalized decision-support tools for cancer screening.

, authors=Jiawei ZHANG1, Yanfei WU1, Sihan WANG2, Jin XIA1, authorsList=Jiawei ZHANG, Yanfei WU, Sihan WANG, Jin XIA, authorCompany=null, correspAuthors=Jin XIA, authorNote=null, correspAuthorsNote=
XIA Jin, E-mail:
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概述了癌症病人一级亲属癌症筛查决策困境的现状,总结了个体、医疗、社会支持与健康素养、疾病认知与风险感知等因素对筛查决策困境的影响,并提出了应对策略,旨在为国内医护人员开发个体化筛查决策辅助工具提供参考。

, authors=张佳巍1, 吴妍霏1, 王思涵2, 夏瑾1, *, *, authorsList=张佳巍, 吴妍霏, 王思涵, 夏瑾, authorCompany=null, correspAuthors=夏瑾, authorNote=

张佳巍,护士,硕士研究生在读

, correspAuthorsNote=
夏瑾,E-mail:
XIA Jin, E-mail:
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癌症病人一级亲属癌症筛查决策困境的研究进展
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张佳巍 1 , 吴妍霏 1 , 王思涵 2 , 夏瑾 1, *, *
护理研究 | 科研综述 2026,40(4): 684-688
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护理研究 |科研综述 2026 , 40 (4) : 684 -688
癌症病人一级亲属癌症筛查决策困境的研究进展
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张佳巍1, 吴妍霏1, 王思涵2, 夏瑾1, *, *
作者信息
  • 1重庆医科大学附属第二医院,重庆 400010
  • 2南部县人民医院
通讯作者:
夏瑾,E-mail:
XIA Jin, E-mail:
作者简介:

张佳巍,护士,硕士研究生在读

Research progress on the decisional conflict of cancer screening for first-degree relatives of cancer patients
Jiawei ZHANG1, Yanfei WU1, Sihan WANG2, Jin XIA1
Affiliations
  • 1The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010 China
  • 2Nanbu People's Hospital
  • Corresponding Author:
    XIA Jin, E-mail:
出版时间: 2026-02-25 doi: 10.12102/j.issn.1009-6493.2026.04.024
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概述了癌症病人一级亲属癌症筛查决策困境的现状,总结了个体、医疗、社会支持与健康素养、疾病认知与风险感知等因素对筛查决策困境的影响,并提出了应对策略,旨在为国内医护人员开发个体化筛查决策辅助工具提供参考。

癌症筛查  /  一级亲属  /  决策困境  /  综述

This article reviewed the current situation of the decisional conflict in cancer screening for first-degree relatives of cancer patients.It summarized the influence of factors such as individuals,medical care,social support and health literacy,disease cognition and risk perception on the dilemma of screening decision-making.Furthermore,it proposed potential strategies to address these challenges,with the aim of guiding healthcare professionals in developing personalized decision-support tools for cancer screening.

cancer screening  /  first-degree relatives  /  decisional conflict  /  review
张佳巍, 吴妍霏, 王思涵, 夏瑾. 癌症病人一级亲属癌症筛查决策困境的研究进展. 护理研究, 2026 , 40 (4) : 684 -688 . DOI: 10.12102/j.issn.1009-6493.2026.04.024
Jiawei ZHANG, Yanfei WU, Sihan WANG, Jin XIA. Research progress on the decisional conflict of cancer screening for first-degree relatives of cancer patients[J]. Chinese Nursing Research, 2026 , 40 (4) : 684 -688 . DOI: 10.12102/j.issn.1009-6493.2026.04.024
癌症作为全球性的健康问题,其发病率和死亡率持续上升。根据国家癌症中心数据显示,2022年中国约有482万例新发癌症病例和257万例新发癌症死亡病例[1]。流行病学研究证实,癌症筛查能有效降低癌症死亡率以及延长生存时间,筛查和早诊早治是降低疾病负担的重要方式[2]。《健康中国行动——癌症防治行动实施方案(2023—2030年)》[3]中也强调了癌症早筛早治的重要性。遗传性癌症病人的一级亲属作为高风险人群[4],其在面临疾病筛查决策时会面临不确定性甚至产生决策困境[5],对于筛查的焦虑、不安等种种心理因素导致了筛查的不连续性[6]。国内外关于决策困境相关研究涉及的领域较为广泛,研究内容多集中于病人治疗或手术方式的决策困境、家属代理决策等。已有研究者关注到一级亲属筛查行为的研究[7],但是目前国内有关一级亲属癌症筛查决策困境的研究尚处于探索阶段。因此,本研究综述癌症病人一级亲属癌症筛查决策困境的相关研究进展,探讨影响一级亲属筛查决策的关键因素,总结决策困境应对策略,以期为我国医护人员制定个性化的癌症筛查决策辅助干预措施提供思路。
癌症的早期筛查、早期诊断与早期治疗是全球范围内公认的、能够有效降低癌症发病率和死亡率的方法,特别是对于具有遗传性风险的人群而言,确保其接受癌症筛查是最具成本效益、最为高效的健康策略[8]。遗传性癌症病人的一级亲属可能会受遗传认知的影响,对自身患癌风险存在不同程度的担忧。同时,癌症的额外负担可能也会影响亲属的应对能力,影响其对疾病防治和筛查的认识[9]。Li等[10]开展了一项关于结直肠癌病人一级亲属结肠镜检查筛查影响因素的系统评价,其中提到目前有关癌症风险和筛查策略的常识可能不足以帮助一级亲属识别一些常见的误解并做出适当的筛查决策。这与吴晓丹等[11]研究结果一致,尽管一些研究对象知道自己作为遗传性大肠癌病人的一级亲属面临着较高的大肠癌发病风险,但仍有4.7%的受访者表示,即便大肠癌筛查是免费的,他们也拒绝接受筛查[11]。这可能因为:一方面他们害怕结直肠镜检查可能会带来不舒适感;另一方面,这部分人依然认为自己的患癌风险不高,认为筛查并非必要,说明仍有部分一级亲属对于自身癌症风险认知不足。此外,国内一项调查研究发现,遗传性乳腺癌-卵巢癌综合征(HBOC)病人的一级亲属接受癌症基因筛查的现况并不乐观,只有32.3%的18岁以上一级亲属决定进行基因筛查和遗传风险管理[12]。尽管存在遗传风险,但一级亲属知晓其风险并接受基因筛查的比例仍然较低。总的来说,遗传性癌症病人的一级亲属癌症筛查现状不容乐观,其对于癌症筛查风险的认知水平整体较低,在做筛查决策时存在一定的困境。
决策困境又叫决策冲突,主要指当个体面临不同的风险、潜在的损失、预期的后悔以及挑战人生价值观的多种选择时,对选择的不确定状态[13],是病人在做出与健康相关的决策时面临的常见问题。当面对选择时,决策者无法做出准确的选择和判断,就容易产生决策困境[5],这种不确定性会影响其行为、情感、健康结局及医疗服务的应用[14]。在面临决策困境时,病人常常会感到高度的决策不确定性,这一过程常伴随着焦虑情绪,担忧治疗效果可能无法达到预期,并因此而产生决策后悔[15]。国内一项针对结直肠癌病人一级亲属的研究发现,有相当大比例的一级亲属在筛查决策上存在困境,50.8%的研究对象存在决策延迟,32.0%存在决策困境[16]。国外研究同样显示,尽管乳腺癌病人普遍认识到乳房肿块是乳腺癌的主要临床表现,但仍有部分人对乳腺癌早期筛查存在认知不足,导致筛查决策困境[17]。此外,健康人群做出医疗保健相关决策时,也会因为对于风险与益处的不确定而产生决策困境。如一项在加拿大进行的多中心大样本量横断面调查研究显示,在传染病流行期间大部分的研究者健康管理决策需求未得到满足,17%存在决策困境[18]。不论是健康人群还是病人在面临决策困境时,所做出的决策更容易引起决策后悔,影响其做出正确的健康决策或疾病诊疗决策。因此,为了避免决策困境导致的严重后果,了解决策困境的影响因素是关键,同时应在未来研究中开发癌症病人一级亲属癌症筛查决策辅助干预策略,缓解其筛查决策困境,提高人群疾病筛查意识,进一步推动癌症早诊早治工作的开展。
调查研究显示,年龄、性别、文化程度、收入等人口学特征会影响病人的决策困境水平[11,19-20]。研究发现,性别是影响一级亲属筛查决策的重要因素,男性亲属对自身癌症风险的认知往往低于女性亲属[12]。同时,筛查态度、害怕应对筛查结果等心理也会影响健康人群的筛查决策。研究表明,有部分人群因害怕筛查结果而选择不进行筛查,对于筛查持有消极态度[21],反映了心理因素对筛查决策的重要影响。此外,家庭收入和经济状况也是影响其筛查行为的重要因素。研究显示,筛查项目的高成本与筛查率降低显著相关,如果没有不适或症状,乙型肝炎病人不会进行肝癌筛查[22]。因此,癌症筛查决策困境研究中应考虑个体因素的影响。
一项针对肝癌筛查的调查研究表明,肝癌高危人群未进行筛查或监测的最常见原因是缺乏专业的医疗建议,医生的建议将提高人们对肝癌筛查的认识和筛查的意愿[23]。此外,常规门诊访视也有助于提高肝癌筛查的依从性。每年临床访视次数较多的病人接受定期筛查的可能性是每年临床访视次数较少的病人的3.4倍[24]。具体而言,当一级亲属感受到医护人员的关心和支持时,他们更有可能积极参与筛查。在某些国家和地区,由于医疗费用高昂或筛查资源有限,一级亲属可能面临筛查可及性不足的问题。这导致他们即使意识到筛查的重要性,也可能因为经济或资源限制而无法进行筛查[25]。因此,考虑筛查决策困境影响因素时,不仅要考虑个体因素,还要考虑医疗资源及经济方面的因素,才能制定出更为精准的筛查路径。
研究发现,社会支持水平越高,所表现出的决策困境水平越低,其进行筛查的可能性越大[26],这表明社会支持对缓解筛查决策困境具有积极作用。同时,一项研究发现,决策困境与健康素养管理呈负相关,提高健康素养有助于降低筛查决策困境的水平[27]。因此,健康素养较高的一级亲属更有可能了解筛查的重要性并主动进行筛查。在日常生活中,医疗卫生机构人员可以通过开展相关教育活动提高筛查目标人群的社会支持水平及健康素养。
病人及一级亲属对癌症及筛查的认知水平会影响其筛查决策。研究发现,超过90%的病人知道肝硬化是肝癌的危险因素,超过85%的病人了解超声检查在肝癌诊断中的作用,他们更能接受肝癌的筛查,以早期发现癌症,从而获得更好的治疗[28]。因此,一级亲属对于疾病的认知程度越清晰,其进行筛查的可能性就越大,疾病相关知识的增加与常规筛查的概率呈正相关[29]。
此外,一级亲属对癌症风险的感知程度也会影响其筛查决策。一级亲属越多地参与癌症风险沟通,筛查率就越高[30]。同时,家属对于疾病的风险和严重程度感知越多,筛查意愿就越高。研究发现,在有乙型肝炎和肝癌家族史的病人中,肝癌的筛查动机和意向更高,这可能因为他们意识到该疾病的危险因素与自己患肝癌的机会增加息息相关[31]。当亲属感知到较高的癌症风险时,他们更有可能积极参与筛查和风险管理。因此,在开发癌症筛查决策困境干预措施时,应考虑疾病认知与风险感知因素,采取针对性的措施提高一级亲属对于疾病的认知,引导其正确认识疾病相关知识,并提高风险感知度,进一步提高其癌症筛查率。
癌症筛查决策是决策者基于自身相关因素(包括家族史、文化程度、家庭收入及人生价值观等)并结合所接触到的医疗建议而做出。决策辅助工具(decision aids,DAs)是基于循证医学而开发出的一种为临床病人提供决策相关信息的工具[32]。决策辅助工具的开发基于国际标准(International Patient Decision Aid Standards,IPDAS)而展开[33],具有标准化的流程,使得决策辅助工具的开发流程更具有科学性,同时也避免了开发者自身主观因素的影响。癌症筛查决策辅助工具开发要点包括提供健康信息支持(关于癌症筛查的利弊)、筛查的可选项、价值澄清工具以及对于风险的解释。决策辅助工具能够帮助病人及家属更好地了解筛查相关知识、权衡决策的获益与风险,支持其更好地做出明智的医疗决策,并与个人价值观和偏好相一致。研究显示,与没有决策辅助工具相比,筛查决策辅助工具能够提高决策者对筛查相关知识的认识、对筛查风险的感知以及帮助其更好地做出决策,同时显著地降低了决策冲突水平[32]。进行癌症筛查的人群具有不同的社会背景及价值观[34],因此,决策辅助工具的开发考虑到不同的场景及应用人群,常常以多种形式及媒介进行决策干预。目前,癌症筛查决策辅助工具的类型包括纸质化手册、视频、健康信息交互式网站及软件等。
Roberto等[35-36]研究发现,使用决策辅助工具为乳腺癌筛查目标人群提供乳腺癌筛查基本信息、筛查的利弊,并在此基础上结合受众人群的个人偏好给予决策辅助支持,能够有效促进筛查决策的实施。此外,一项研究基于渥太华决策支持框架(Ottawa Decision Support Framework,ODSF)开发了一种决策辅助工具,专门用于帮助有前列腺癌家族史的男性做出前列腺癌筛查决策;该工具根据男性的年龄和家族史进行风险分级,提供个体化的决策信息,包括个人筛查偏好表、基于在线网站的网络版决策辅助工具,帮助其衡量筛查的利弊;结果显示,使用纸质版和(或)网络版决策辅助工具能够提高前列腺癌家族史者对于筛查的认知,明确筛查的获益与风险,减少决策冲突同时提高决策质量[37]。
决策辅助工具能够根据决策者的价值偏好进行个性化的决策支持,推动共享决策的实施,有效缓解筛查决策者的决策困境水平。但是从决策实施的有效性方面来看,病人或决策者须具备足够的健康素养和知识,以理解可用选项之间的利弊权衡,并与医护人员共同做出明智的选择,才能做出有效的共享决策。所以,决策者的自身相关因素是决策辅助工具开发与实施过程中需要重点考虑的要点。目前,筛查决策辅助工具的开发研究较多,但大部分为国外研究者所开发。已开发的癌症筛查决策辅助工具在我国的适用性及可行性有待进一步研究验证。同时,已开发的工具也需要根据适用场景及人群及时更新及调整。我国医护人员工作负担较重,医护人员在日常工作中由于时间限制并且与癌症病人一级亲属接触有限,难以充分倡导家庭成员进行癌症筛查[38]。因此,应该提高我国医护人员自身素养及对共享决策的重视程度,更好地促进临床决策辅助工具的开发。建议未来研究者可以参考国外相关研究,并结合我国的临床实际以及病人就医环境差异,开发本土化的筛查决策辅助工具,缓解一级亲属筛查决策冲突现状,提高其癌症风险认知水平,促进高质量决策的制定与实施。
为改善一级亲属的癌症筛查决策困境水平需要综合考虑多种因素,制定个性化的决策辅助干预措施,提高其对癌症筛查的认知和接受度。国外对于癌症筛查决策困境研究范围较广,包括有筛查决策困境影响因素分析及筛查决策辅助工具的研制等。目前,国内针对癌症病人一级亲属决策困境研究还处于起步阶段,未来研究可以进一步深入探索不同文化背景、地区之间影响筛查决策的因素,以更全面地理解一级亲属在筛查决策中的行为和心理。同时,参考国外关于癌症筛查决策辅助工具的相关研究,开发适合于我国的个体化决策辅助干预措施,如基于互联网的个性化筛查建议系统、智能筛查助手等,缓解一级亲属决策困境,提高该类人群的筛查参与度和筛查效果。此外,可以加强跨学科合作,结合心理学、社会学等多领域知识,提高一级亲属对癌症风险的认知,共同推动一级亲属癌症筛查决策研究的发展和进步。

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doi: 10.12102/j.issn.1009-6493.2026.04.024
  • 接收时间:2024-12-04
  • 首发时间:2026-10-28
  • 出版时间:2026-02-25
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  • 收稿日期:2024-12-04
  • 修回日期:2026-01-27
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    1重庆医科大学附属第二医院,重庆 400010
    2南部县人民医院

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