影响精神分裂症患者参与医疗决策意愿的相关因素

Related factors affecting the desires of patients with schizophrenia to be involved in medical decision

目的：了解影响精神分裂症患者参与医疗决策意愿的相关因素。方法：选取符合1CD-10诊断标准的精神分裂症患者162例，采用白编问卷，调查患者参与医疗决策的意愿，以患者性别、年龄、受教育程度、婚姻状况、职业、收入、医疗费用支出方式、病程为白变量，以患者参与医疗决策意愿为因变量，进行多因素logistic回归分析。结果：男性患者较女性患者主动沟通和主动决策可能性均大（OR=5．166，OR=5．673）；年龄≤45岁的患者较年龄〉45岁的患者主动需求信息可能性大（OR=4．509），而主动决策可能性小（OR=0．161）；低、中等受教育程度的患者较高等受教育程度的患者主动需求信息和主动决策可能性均小（OR=0．097，OR=0．242）；有收入的患者比无收入的患者主动沟通和主动决策可能性均大（OR=4．481，OR=6．494～20．855）；医保或公费患者较白费或农合患者主动需求信息和主动沟通可能性均大（OR：3．708，OR=4．501），但主动决策可能性小（OR=0．156～0．222）；病程≤10年的患者比病程〉10年的患者主动需求信息、主动沟通和主动决策可能性均小（OR=0．296，OR=0．142，OR=0．288）。结论：性别、年龄、受教育程度、收入、医疗费用支出方式及病程均对患者参与医疗决策意愿有一定的影响，而且对医疗决策的3个方面所产生的影响不尽相同。

Objective:To investigate the related factors, which affect the desires of the outpatients with schizophrenia to partic-ipate in making medical decisions. Methods:Totally 162 outpatients with schizophrenia meeting the diagnostic criteria of international classification of diseases and related health problems, tenth revision (ICD-10) for schizophrenia, were recruited. By using a self-de-signed questionnaire, their desires to participate in making medical decisions were investigated, and multivariate logistic regression a-nalysis was performed to assess the association among the independent variables ( gender, age, education level, marital status, occupa-tion, income, medical expenses and duration of illness) and dependent variables ( the willingness to participate in making medical de-cisions) . Results:Male patients were more likely than female patients to prefer a more active role in the willingness to communicate and medical decision (OR=5. 166, OR=5. 673); patients whose ages were less than 45 years old were more likely than patients whose ages were over 45 years old to prefer a more active role in the requirement for related information, but less likely to prefer a ac-tive role in medical decision (OR=0. 161);low and middle education level patients were less likely than high education level patients to prefer a more active role in the requirement for related information and medical decision (OR=0. 097, OR=0. 242);patients with incomes were more likely than patients without incomes to prefer a more active role in the willingness to communicate and medical deci-sion (OR=4. 481, OR=5. 719-20. 855); patients with urban medical insurance or free medical care were more likely than patients with rural cooperative medical insurance or medical at their own expense to prefer a active role in the requirement for related information and willingness to communicate, but less likely to prefer a active role in medical decision (OR=3. 708, OR=4. 501, OR=0. 156-0. 222);patients whose duration of illness were less than 10 years were less likely than patients whose duration of illness were over 10 years to prefer a more active role in the requirement for related information, willingness to communicate and medical decision (OR=0. 296, OR=0. 142, OR=0. 288). Conclusions:In some degrees, gender, age, education level, income, medical expenses and dura-tion of illness affect the desires of the patients with schizophrenia to participate in making medical decisions, and the effects varied in the three dimensions of medical decisions.