住院患者对医生的信任水平及自我效能与医疗决策行为的关系研究——以医患互动为中介

The relationship between the level of trust and self-efficacy of hospitalized patients and the behavior of medical decision-making:Using physician-patient interactions as the mediator

目的:通过调查杭州市住院患者参与医疗决策行为现状,分析其主要影响因素和机制,为提高杭州市住院患者参与医疗决策积极性、有效性提出建议。方法:采用分层随机抽样的方法,参考成熟量表后自行设计的调查问卷,对杭州市二、三级医院的750名住院患者进行调查;用结构方程模型分析住院患者对医生的信任水平、参与决策自我效能、医患互动与其参与医疗决策行为的作用机制。结果:不同家庭月收入、住院科室、过去一年住院次数、本次入院决策方案制定方式的患者参与医疗决策行为得分有显著性差异(均P<0.05)。患者参与医疗决策行为与其对医生的信任水平呈负相关;与其自我效能和医患互动呈正相关(P<0.01)。患者对医生的信任水平和自我效能直接影响患者参与医疗决策行为,直接效应值分别为-0.373、0.358(P<0.001);医患互动在对医生的信任水平、自我效能与患者参与医疗决策行为之间的关系中起较显著的中介作用,中介效应值分别为-0.089、0.328(P<0.001)。结论:医患互动的中介效应可以促进患者参与医疗决策行为的积极性和有效性,医疗卫生机构应以患者为中心,优化住院患者参与医疗决策的途径,加强对医务人员医患互动能力和意识的培训,切实提高患者参与医疗决策行为的主动性和有效性。

Objective:To investigate the status quo of inpatients'participation in medical decision-making in Hangzhou,analyze the main influencing factors and mechanisms,and put forward suggestions for improving the effectiveness of inpatients'participation in medical decision-making in Hangzhou.Methods:750 inpatients in secondary and tertiary hospitals in Hangzhou were investigated by stratified random sampling using a self-designed questionnaire based on the reference maturity scale.Structural equation model was used to analyze the level of trust of hospitalized patients in doctors,the mechanism of self-efficacy of participating in decision-making,doctor-patient interaction and their participation in medical decision-marking behavior.Results:There were significant differences in the scores of medical decision-making behaviors among patients with different family monthly income,hospitalization department,hospitalization times in the past year,and the decision-making method of this admission(all P<0.05).There was a negative correlation between patients'participation in medical decision-making and their trust in doctors.It was positively correlated with self-efficacy and doctor-patient interaction(P<0.01).Patients'trust in doctors and self-efficacy directly affected patients'participation in medical decision-making,with the direct effect values of -0.373 and 0.358(P<0.001),respectively.Doctor-patient interaction played a significant mediating role in the relationship between the level of trust in doctors,self-efficacy and patients'participation in medical decision-making,with the mediating effect sizes of -0.089 and 0.328(P<0.001),respectively.Conclusion:The mediating effect of doctor-patient interaction can promote the enthusiasm and effectiveness of patients'participation in medical decision-making.Medical and health institutions should take patients as the center,optimize the way for inpatients to participate in medical decision-making,strengthen the training of doctor-patient interaction ability and awareness of medical staff,and effectively increase the proactivity and effectiveness of patients’behavior to participate in medical decision-making.