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For most breast cancer (BC) patients who have undergone a mastectomy, the decision whether to proceed with breast reconstruction (BR) is complicated and requires deliberation. Shared decision-making (SDM) helps to address those needs and promote informed value-based decisions. However, little is known about the SDM status for BR in BC patients. This scoping review describes: 1) basic characteristics of studies on BR SDM in BC patients; 2) factors influencing BR SDM in BC patients; 3) experience and perception of BR SDM in BC patients; and 4) outcome measures reported. This review was performed in accordance with the Arksey and O’Malley methodology. A total of 5 English and 4 Chinese databases were searched, as well as different sources from grey literature. The data extraction form was developed by referring to the objectives and the Ottawa Decision Support Framework (ODSF). Data was analyzed using thematic analysis, framework analysis and descriptive statistics, with findings presented in the tables and diagrams. A total of 1481 records were retrieved and 42 of these included after screening. In 21 (21/42, 50%) of the studies, patient decision aids (PDAs) were utilized, and in 17 (17/42, 40.48%) of the studies, the factors influencing the implementation of SDM were explored. Of these 17 studies, the factors influencing the implementation of SDM were categorized into the following: the patient level (17/17, 100%), the healthcare level (2/17, 11.76%) and the organizational and system level (7/17, 41.18%). A total of 8 (19.05%) of the 42 studies focused on patients’ experiences and perceptions of SDM, and all studies used qualitative research methods. Of these 8 studies, a total of 7 (7/8, 87.50%) focused on patients’ experiences of SDM participation, and 4 (4/8, 50.00%) focused on patients’ perceptions of SDM. A total of 24 studies (24/42, 57.14%) involved quantitative outcome measures, where 49 items were divided into three classifications according to the outcomes of ODSF: the quality of the decision (17/24, 70.83%), the quality of the decision-making process (20/24, 83.33%), and impact (13/24, 54.17%). Although researchers have paid less attention to other research points in the field of SDM, compared to the design and application of SDM interventional tools, the research team still presents some equally noteworthy points through scoping review. For instance, the various factors influencing BC patients’ participation in SDM for BR (especially at the healthcare provider level and at the organizational system level), patients’ experiences and perceptions. Systematic reviews (SRs) should be conducted to quantify the impact of these different factors on BR SDM. Implementation of scientific theories and methods can inform the exploration and integration of these factors.

For most breast cancer patients, the decision to proceed with breast reconstruction is complicated and requires deliberation. Shared decision-making (SDM) is ideally suited to this clinical situation to make a high-quality treatment and preference-concordant decision. But there is no comprehensive overview of existing SDM interventions for breast reconstruction in breast cancer. Therefore, the aim of this scoping review is to understand the current situation of SDM in breast reconstruction for breast cancer, including the decisional needs, decisional support and decisional outcomes.

The theory of clinical nursing is a systematic, theoretical and logical description of the nursing phenomenon and its essence, which can be used to explain the clinical nursing phenomenon and its relationship, and predict and control the nursing outcome. Nursing theory is very important to guide clinical practice and avoid practice blindness. With nursing as a first-level discipline, the research on nursing theory in China has gradually increased, but it is still in the primary stage of introducing, learning, validating application and understanding of nursing theory abroad. Compared with theoretical research in other mature fields or foreign nursing theory, the number of research is insufficient. Therefore, the nursing discipline needs to strengthen the research on the basic evolution mechanism and develop the nursing theory, to improve the scientific nature and popularization of nursing practice. Realist review, also known as Realist synthesis, is a theory-driven systematic review of complex interventions from the perspective of Realist philosophy. It does not answer the question of whether interventions are effective or not, but rather explains the theoretical mechanism by which interventions work, that is, explaining "what interventions can be applied to what populations in what contexts". This method was developed by Sociology professor Ray Pawson and gradually expanded from social policy formulation to health care, public health, health-related policy formulation, and other fields. The number of articles applying this method in nursing is increasing. However, no scholars in China have published such studies at present. Only scholars have expounded the philosophical view of realism integration and its difference from systematic reviews from a philosophical perspective, as well as introduced and interpreted the reporting standard of realism review. At present, there is still a lack of systematic review and evaluation of these studies. Scoping review is a method to quickly describe the research progress of a certain knowledge field, summarize the knowledge of existing studies and understand their shortcomings. Therefore, this study adopted the scoping review framework of Arksey and O 'Malley to sort out and analyze the published realist reviews in the field of nursing at home and abroad, aiming to understand the research status of this field and introduce the theories and methods of realistic reviews, which provides new ideas for theoretical research in the nursing field in China.