Introduction Understanding the breast cancer (BC) patient‘s decisional needs is critical in helping health care professionals (HCPs) provide support to conduct shared decision-making (SDM) and help women make informed breast reconstruction (BR) decisions that are suitable for their clinical and personal circumstances. Therefore, this study aims to explore BC patients‘ participation in BR decision-making and specific decisional needs, especially the manifestations and causes of decisional conflicts, in China.

Methods A mixed-methods study was conducted using triangulation of data from interviews and a questionnaire survey with HCPs and BC patients with BR decision-making experience at 5 Beijing centers. The Ottawa Decision Support Framework guided (ODSF) the qualitative and quantitative data analyses.

Results A total of 82.53% of Chinese BC patients would consider BR. Seven themes captured patients‘ BR decisional needs per the ODSF: inadequate support/resources (100%, 58.82%) and knowledge (75%, 52.94%) were most frequently cited. Health beliefs (unclear values) reflected Chinese characteristics. Patients had inadequate knowledge (M=19.99/50, SD=8.67) but positive BR attitudes (M=59.48/95, SD=10.45).

Discussion Chinese BC patients show positive attitudes but have lower actual involvement in decision-making. Cultural influences, such as patriarchal norms and Confucianism, shape decision- making. BR decisions for Chinese BC patients are complex and often accompanied by decisional conflicts. Inadequate knowledge and inadequate support and resources contribute to these conflicts, emphasizing the need for culturally tailored information and support to promote SDM.

Conclusion HCPs need specialized training in SDM to guide patients in decision-making. It is essential to provide relevant resources and support that are culturally and clinically appropriate for Chinese patients.