A Study on the Participation of Lung Cancer Patients in Surgical Decision-Making and Its Influencing Factors from the Perspective of Ecological Systems Theory

Abstract Aim. To investigate the surgical decision-making and its influencing factors in patients with stages I to IIIa non-small cell lung cancer (NSCLC) under Ecological Systems Theory. Methods. Convenience sampling was used to select 219 surgical patients with stages I to IIIa NSCLC admitted to a tertiary hospital from February 2024 to June 2024, and an electronic questionnaire survey was distributed. The questionnaire included a general information survey, a Control Preference Scale (CPS), and a survey on patients' level of knowledge about medical decisions. Spearman's rank correlation analysis and multiple logistic regression analysis were used to explore the types of surgical decision-making participation and their influencing factors in patients with stages I to IIIa NSCLC. Results. Among the types of participation in surgical treatment decision-making for lung cancer patients, passive decision-making was the most common. Correlation analysis revealed that the type of participation in surgical treatment decision-making was negatively correlated with age and having commercial insurance (both P < 0.01), and positively correlated with educational level, chosen surgical method, and medical decision-making awareness (all P < 0.05). Multiple logistic regression analysis found that age, level of medical decision-making knowledge, and the presence of commercial insurance were influencing factors for the type of surgical decision-making participation (all P < 0.05). Conclusion. Patients who are younger, more informed about medical decisions, and hold commercial insurance are more inclined to adopt shared decision-making or proactive decision-making. Based on the Ecological Systems Theory, at the micro level, healthcare professionals should actively provide targeted decision-making support to promote patients' deeper involvement in surgical decision-making, thereby improving decision quality and health outcomes. At the macro level, medical institutions can strengthen cooperation with insurance companies to design and popularize commercial insurance products that meet patients' needs.