Abstract: Background　Shared decision making（SDM） can improve the quality of life and treatment compliance of breast cancer patients，but there is no study on whether functional exercise compliance as a mediator variable between SDM and quality of life. Objective　To investigate the perceived level of involvement in SDM of breast cancer patients with modified radical mastectomy，and discussed the correlation of SDM，exercise adherence and life of quality. Methods　During the period from January to April 2019，277 breast cancer patients who accepted modified radical mastectomy in Tianjin Medical University Cancer Institute & Hospital were enrolled by means of convenience sampling. A set of questionnaires including socio-demographic questionnaire，the Chinese version of the 9-item Shared Decision Making Questionnaire（SDM-Q-9），the Postoperative Functional Exercise Compliance Scale-Breast Cancer（PFECS-B），and the Chinese version of Functional Assessment of Cancer Therapy-Breast（FACT-B） were used to collect data in a survey. Spearman correlation analysis was used to explore the relationships between SDM，functional exercise adherence and quality of life. AMOS 25.0 was applied to analyze the mediating effect of functional exercise adherence between SDM and quality of life，and to establish a structural equation model containing these three indicators. Results　The median scores of SDM-Q-9 and PFECS-B，and average score of FACT-B for these breast cancer patients were 27（18，34），49（46，53），and （89.38±9.073），respectively. The score of SDM-Q-9 showed a statistically significant positive correlation with that of PFECS-B and FACT-B（P<0.05）. The partial mediating effect of functional exercise compliance between SDM and quality of life was significant（P<0.05）. The direct effect of SDM on quality of life was 0.391 and the mediating effect was 0.299（accounting for 43.3% of the total effect），the total effect was 0.690. Conclusion　Breast cancer patients with modified radical mastectomy may have a low perceived level of involvement in SDM. SDM may directly affect their quality of life，and also may affect it indirectly through the mediating effect of functional exercise adherence.

Key words: Breast neoplasm, Shared decision making, Exercise adherence, Quality of life

摘要： 背景　共同决策可提高乳腺癌患者的生活质量和治疗依从性，但缺乏探讨功能锻炼依从性是否在共同决策与生活质量间作为中介变量的研究。目的　调查乳腺癌改良根治术患者共同决策参与现状，并探讨乳腺癌改良根治术患者共同决策与其功能锻炼依从性、生活质量间的相关性。方法　于2019年1—4月，便利抽取天津医科大学肿瘤医院的277例乳腺癌改良根治术患者作为研究对象，采用一般资料调查表、共同决策问卷-9条目版、乳腺癌术后功能锻炼依从性量表、乳腺癌生活质量评测量表中文版（FACT-B）量表对研究对象进行问卷调查。采用Spearman秩相关分析探讨共同决策与功能锻炼依从性、生活质量的关系，并通过AMOS 25.0软件分析功能锻炼依从性的中介效应，建立共同决策、功能锻炼依从性、生活质量的结构方程模型。结果　我国乳腺癌改良根治术患者的共同决策总得分中位得分为27（18，34）分，功能锻炼依从性中位得分为49（46，53）分，生活质量平均得分为（89.38±9.073）分。共同决策与功能锻炼依从性、生活质量均呈正相关（P<0.05）。功能锻炼依从性在共同决策与生活质量间的部分中介效应显著（P<0.05），共同决策对生活质量的直接效应为0.391，中介效应为0.299，总效应为0.690，中介效应占共同决策对生活质量总效应的43.3%。结论　乳腺癌改良根治术患者的共同决策参与程度较低，共同决策对乳腺癌改良根治术患者的生活质量既存在直接影响，也通过中介变量功能锻炼依从性间接发挥作用。

关键词: 乳腺肿瘤, 共同决策, 功能锻炼依从性, 生活质量