医学新技术临床应用患者参与决策及其影响因素分析

Patient Participation in Decision-making and its Influencing Factors at the Clinical Application of New Medical Technologies

目的研究通用概念的医学新技术及无创产前检测技术临床应用中的患者参与决策,分析相关影响因素。方法采用多阶段分层抽样,选取东西部的上海、福州、泉州、成都、南充5城市18家医院为样本点,对医院妇产科孕妇及其他科室患者进行调研,问卷为自主设计,包含通用新技术及具体新技术(NIPT技术)两个视角,采用logistic回归分析进行影响因素分析。结果共调查233名孕妇和554名其他科室患者;69名(占41.12%)孕妇和310名(占64.32%)患者的参与决策量表得分为"较高";孕妇受教育程度、医疗保险情况、医疗服务满意度,对孕妇参与决策程度差异有统计学意义(P<0.05);对于通用新技术,城市地区、是否本地人员、患者对新技术的态度、医疗服务满意度差异有统计学意义(P<0.05)。结论多数患者参与了新技术诊疗决策,但其实际程度仍待提高;多因素影响患者决策参与,对于不同新技术有不同的影响因素。建议多途径促进患者合理地参与决策,推动医患共同决策模式的建立。

Objective To study the patients＇ participation in decision-making at the clinical application of general new medical technology and non-invasive prenatal testing（NIPT） and to analyze its influencing factors. Methods A cross-sectional survey was conducted in Shanghai, Fuzhou, Quanzhou, Chengdu and Nanchong City. Pregnant women and other patients were investigated with self-designed questionnaire. Associating factors were analyzed in logistic regression. Results A total of 233 pregnant women and 554 other patients from 18 hospitals in 5 cities were surveyed;69（41.12%） pregnant women and 310（64.32%） patients were rated＂higher＂in their involvement in decision-making. The education level,medical insuance and service satisfaction were associated with pregnant women＇s involvement（P〈0.05）;for general new medical technology,city,whether local native,the attitude to new medical technology and the service satisfaction were found to be significant factors（P〈0.05）. Conclusion Many patients reports to have participated in the decision-making,but the level of involvement still needs to be improved. Multi-factors affect patients＇ involvement in decision-making,and factors varies among different new technologies. It is suggested to take various measures to encourage patients＇ participation and promote physician-patient shared decision-making at the application of new medical technology.