Experiences of decisional conflict related to epidural labour analgesia among women during late pregnancy in a tertiary hospital in China: a mixed methods study.

BACKGROUND: Research has indicated some women were in a state of uncertainty about pharmacological pain management decisions, which may lead to maternal anxiety and decisional regret. However, little is known about decisional conflict in the choice of epidural labour analgesia amongst Chinese women. AIM: This study aimed to investigate the level of and reasons underlying decisional conflict in Chinese women during their late pregnancy when making a decision on the use of epidural analgesia in labour. METHODS: A convergent parallel mixed methods study was undertaken, that included a quantitative survey (n = 323) and qualitative interviews (n = 17) with women recruited from a tertiary general hospital in Hangzhou, China. The quantitative survey assessed the level of and its influencing factors of women's decisional conflict, while the qualitative interview further explored experiences of and reasons underlying the conflict. FINDINGS: Participants reported a high level of decisional conflict (mean±SD, 39.59±15.92), which related to decision delay and/or negative perceptions about the decision. Multiple stepwise linear regression analysis identified that highest level of education and knowledge of epidural were negatively associated with decisional conflict (p<0.05). Four decision-making styles (rational, dependant, intuitive and avoidant decision-making) associated with different levels of decisional conflict, and four underlying reasons (personal characteristics, informational provision, emotional support and participation in decision-making) of the conflict were thematized. CONCLUSION: Decisional conflict related to epidural labour analgesia is a noteworthy issue amongst women during their late pregnancy. This study suggests a need for provision of family-centred shared decision-making practice about the use of epidural analgesia in labour.

Development of mobile health-based self-management support for patients with lung cancer: A stepwise approach.

AIM: To develop self-management support platform on mobile for Chinese patients with lung cancer. DESIGN: A stepwise approach with combination of methods. METHODS: Literature review was carried out to construct preliminary framework and develop detailed content for self-management modules. A semistructured interview was conducted to elicit preference in the content and platform of self-management modules with 15 patients with lung cancer. Delphi study was performed to evaluate and improve the content of modules with 13 experts. A pilot study was conducted to test the mobile health-based self-management support modules with 13 patients with lung cancer. RESULTS: A social network software-based WeChat public account "Symptom Self-Management" for patients with lung cancer was developed and preliminarily tested with positive feedback. Three modules were designed and presented, including symptom management (cancer-related fatigue, cough, dyspnoea, pain, nausea and vomiting), emotion management and role management. CONCLUSION: This study showed that patients with lung cancer have diversified supportive care needs after discharge. A bottom-up and stepwise approach to develop mobile health-based self-management support tool has shown to be feasible and valuable. Theory guidance, user requirement exploration, evidence-based information and expert evaluation are key elements of the process. IMPLICATIONS FOR PRACTICE: The WeChat Public Account "Symptom Self-Management" could be used as sustainable platform to support patients with lung cancer in dealing with common challenges. It provides professional information, self-assessment tools, self-management skills and peer-support platform. Information presented in both text and audio forms enables patients' easy access to the platform.