背景：随着医学模式向“生物-心理-社会”转变，患者权利意识逐渐觉醒，如今“以患者为中心”的医疗照护理念逐渐融合于医疗体系中，医患共同决策（shared decision-making, SDM）模式进入医疗工作者的视野。绝经综合征的一线药物治疗措施是绝经激素治疗（menopausal hormone therapy, MHT），但应用激素除了受多重风险与收益影响外，也受围绝经期妇女自身偏好和需求的影响，因此根据客观医疗证据与妇女的实际需求，合理制定医疗决策十分必要。

目的：本研究基于医患共同决策概念，结合定量研究与定性分析，描述当前国内绝经综合征绝经激素治疗的医患共同决策质量现状，并分析影响决策质量的因素，进一步通过访谈分析围绝经期妇女决策背后的原因。以期为实现对围绝经期妇女更优质的临床照护提供理论依据，帮助围绝经期妇女更顺利地过渡到老年期。

方法：本研究结合问卷调查法和半结构化访谈法进行研究，采用便利抽样的方法，从北京市某三级甲等医院妇科内分泌中心抽取进行绝经激素治疗的围绝经期妇女，使用自设问卷、中文版共同决策问卷患者版（SDM-Q-9）调查共同决策质量。半结构化访谈中采用自设访谈提纲，访谈内容包括妇女对决策过程的认知、妇女对医疗信息的态度、影响激素使用的因素等。问卷收集到的数据导入SPSS26.0，采用非参数检验和多元线性回归进行统计分析。录音资料转写为文字稿后导入Nvivo12.0，资料分析方法为Colaizzi七步分析法。

结果：研究回收109份问卷，有效问卷101份，有效率92.7%。本研究中决策质量得分为（89.75±10.012）分；妇女平均年龄（53±5.92）岁，年龄范围为41~73岁；使用连续联合方案（54.5%）的妇女稍多于使用序贯方案（41.6%）的妇女，大部分妇女认为激素治疗的效果好（88.1%）。潮热多汗（68.3%）、失眠（52.5%）、骨关节痛（32.7%）是症状检出率前三位，医生建议使用（30.7%）、担心很快衰老（19.8%）、希望继续来月经（16.8%）是社会心理因素前三位。单因素分析显示生育情况、潮热出汗、失眠、情绪波动、治疗效果感受、由医生建议使用激素是决策质量的影响因素（P<0.05）。多元线性回归结果显示生育状况（β=0.262，P=0.005）、潮热出汗（β=0.194，P=0.044）、失眠（β=0.227，P=0.017）、医生建议使用（β=0.206，P=0.025）可解释决策质量23.7%的变异。10名被访谈妇女的平均年龄为（55±9.30）岁，使用序贯方案的有4名，使用连续联合方案的有6名，激素治疗年限大部分在5年以内（70%），最长的年限为22年。基于访谈结果提炼出9个亚主题，归纳为3个主题：围绝经期妇女倾向由医生主导决策过程、激素治疗的使用受多种因素影响、治疗满意度影响就医体验的评价。

结论：围绝经期妇女的决策参与意愿较高，医生需明确引导决策的行为；医生主导下的决策取得了较好的治疗效果；决策参与意愿与实际参与决策的情况存在差异，需要探索更适用于进行MHT妇女的决策模式。建议进一步推动SDM理论研究落地；优化MHT的治疗可及性，完善社区管理作用。

Background: As the medical model shifts towards the “bio-psycho-social” approach and patients’ awareness of their rights increases, the concept of patient-centered care has been gradually integrated into the medical system, and the shared decision-making (SDM) model between doctors and patients has gained the attention of healthcare providers. Menopausal hormone therapy (MHT) is the first-line treatment for menopause syndrome. Its application is affected by not only risks and benefits factors, but also perimenopause women's own preferences and needs. Therefore, it is necessary to make reasonable medical decisions based on objective medical evidences and women’s needs.

Objective: To describe the current status of SDM quality in MHT in China and analyze factors that affect it, this study combines quantitative research with qualitative analysis based on the concept of shared decision-making. It further explores reasons behind decisions made by perimenopause women through interviews. The aim is to provide theoretical basis for achieving better clinical care for menopause women and help them improve quality of life in old age.

Methods: This study used a combination of questionnaire survey and semi-structured interview methods. Convenience sampling was used to select perimenopause women who were undergoing menopausal hormone therapy from Center for Gynecological Endocrinology of a top hospital in Beijing. A self-designed questionnaire and the Chinese version of 9-items shared decision making questionnaire (SDM-Q-9) were used for SDM quality research. In semi-structured interview, a self-designed interview outline was used. The interview content included women's understanding of the decision-making process, attitudes towards medical information, factors influencing hormone use, etc. The data collected from the questionnaire were imported into SPSS 26.0 for statistical analysis using non-parametric tests and multiple linear regression. The recorded interviews were transcribed into text and imported into Nvivo 12.0 for analysis using the Colaizzi seven-step analysis method.

Results: 109 questionnaires were collected, and 101 valid questionnaires were obtained, with an effective rate of 92.7%. The SDM quality score in this study was (89.75±10.012). The average age of women was (53±5.92) years old, ranging from 41 to 73 years old. Women using continuous combined therapy (54.5%) were slightly more than those using sequential therapy (41.6%), and most women believed that MHT was effective (88.1%). The top three symptoms detected were hot flashes and sweating (68.3%), insomnia (52.5%), and joint pain (32.7%). The top three social and psychological factors were doctor’s recommendation for use (30.7%), fear of aging quickly (19.8%), and desire to continue menstruation (16.8%). Univariate analysis showed that fertility status, hot flashes and sweating, insomnia, mood swings, perceived treatment effectiveness, and doctor’s recommendation for use were all factors affecting SDM quality (P<0.05). Multiple linear regression results showed that fertility status (β=0.262, P=0.005), hot flashes and sweating (β=0.194, P=0.044), insomnia (β=0.227, P=0.017), and doctor’s recommendation for use (β=0.206，P=0 .025) could explain 23.7% of the variation in SDM quality. The average age of the 10 interviewed women was (55±9.30) years old. Four of them used a sequential therapy, while six used a continuous combined therapy. The majority of hormone therapy use was within 5 years (70%), with the longest duration being 22 years. Based on the interview results, nine sub-themes were extracted and summarized into three main themes: perimenopause women tend to have decision-making led by doctors, hormone therapy use is influenced by several factors, and treatment satisfaction affects medical experience.

Conclusions: Perimenopausal women have a higher willingness to participate in decision-making, and doctors need to clearly guide decision-making behavior. Decisions made under the guidance of doctors have achieved better treatment outcomes. There is a difference between willingness to participate in decision-making and actual participation, and it is necessary to explore decision-making models that are more suitable for women undergoing MHT. It is recommended to further promote SDM theoretical research, improve the accessibility of MHT and the role of community management.