住院患者医患关系认知评价及与应激、医生信任度的关系

Relations of inpatients’ cognitive aspects of the doctor-patient relationship to stress and patients’ trust

目的探讨住院患者医患关系认知评价及与应激、医生信任度的关系.方法采用分层整群随机采样方法,选取住院患者565人,采用中国版医患关系量表(Patient Doctor Relationship Questionnaire 13-Item Version,PDRQ-13)、中文版医院应激评定量表[(Hospital Stress Rating Scale,HSRS),包括环境不熟悉(HSRS-1)、不舒适(HSRS-2)、信息缺乏(HSRS-3)、严重疾病的威胁(HSRS-4)、家庭和社会因素(HSRS-5)五个维度]、维克森林医师信任量表中文修订版(Chinese version of Wake Forest Physician Trust Scale,WFPTS)进行现场测评.结果住院患者PDRQ-13条目分均值(2.89)低于中值强度(3.00),低于中值水平(<3.00)以下人数占61.8%.病情呈重度住院患者PDRQ-13评分低于中度或以下患者;三甲医院住院患者PDRQ-13评分低于二甲或以下患者[(35.06±6.54)vs(39.84±6.33),(35.06±6.54)vs(40.46±6.50);(30.30±6.08)vs(40.26±6.58)(30.30±6.08)vs(39.26±6.58),均P<0.001].回归分析显示,WFPTS、HSRS-4评分与PDRQ-13评分回归关系成立(β=0.22、-0.25,均P<0.001),WFPTS×HSRS-4评分、WFPTS×HSRS-3评分与PDRQ-13评分回归关系成立(β=-0.25、-0.22,均P<0.001).结论住院患者医患关系认知评价较低,在医院等级、病情分级之间有差异性表现,受住院信息缺乏、疾病威胁所致应激反应与医生信任度较低的交互影响.

Objective The objective of this study was to explore the relations of inpatients' cognitive aspects of the doctor- patient relationship to stress and patients' trust. Methods Totally 565 inpatients were selected. A survey was performed using the Patient Doctor Relationship Questionnaire 13-Item Version (PDRQ-13), Hospital Stress Rating Scale (HSRS) consisting of the sub-scales of Unfamiliarity with Environment (HSRS-1), Lack of Comforts (HSRS-2), Lack of Information (HSRS-3), Risks of Serious Disease (HSRS- 4), Family and Social Factors (HSRS-5), and Chinese version of Wake Forest Physician Trust Scale (WFPTS). Results The scores of PDRQ-13 were lower than the average score (<3). The PDRQ-13 scores of patients in severe group in terms of severity of illness were lower than those in mild and moderate group [(35.06±6.54) vs (39.84±6.33), (35.06±6.54) vs (40.46±6.50);P < 0.01]. The PDRQ-13 scores of patients in severe group in Grade A Class 3 hospital group were lower than those in Grade A Class 2 hospital groups[(30.30±6.08) vs ( 40.26±6.58), (30.30±6.08) vs (39.26±6.58);P < 0.01]. Regression analysis showed that the PDRQ-13 scores were positively correlated with the WFPTS scores and negatively correlated with the HSRS-4 scores (β=0.22, - 0.25;P < 0.01). Regression analysis also revealed a dependency between the PDRQ-13 scores and the score of WFPTS multiplied by HSRS-4, WFPTS multiplied by HSRS-3 (β= - 0.25, - 0.22;P < 0.01). Conclusions Inpatients had a lower evaluation of the doctor-patient relationship, which was positively related with hospital's professional level and disease severity, and may be interactively influenced by patients′ trust and stress.