老年全膝关节置换术患者参与医疗决策的满意度现状及其影响因素研究

Participation in medical decision-making with the elderly patients undergoing total knee arthroplasty:a study of satisfaction level and influencing factors

目的了解老年人工全膝关节置换术患者参与医疗决策的满意度现状,并分析其影响因素。方法采用便利抽样法,选取2011年6月至9月在长沙某三级甲等医院关节科行全膝关节置换术后门诊随访的244例患者为研究对象,采用一般人口学资料调查表、患者参与医疗决策的满意度量表、简易疾病感知问卷、患者对医疗决策知情程度调查表及医患关系量表进行调查。结果患者参与医疗决策的满意度得分为(77.90±11.51)分,处于中等水平;患者参与医疗决策的满意度与医患关系、患者对医疗决策知情程度呈正相关(r值分别为0.971、0.678,均P<0.05),而与疾病感知呈负相关(r=-0.739,P<0.05)。多元线性回归分析显示,家庭月收入、受教育程度、疾病感知、患者对医疗决策知情程度及医患关系是老年全膝关节置换患者参与医疗决策的满意度的独立影响因素(均P<0.05)。结论老年全膝关节置换患者参与医疗决策的满意度水平不高,疾病感知、患者对医疗决策知情程度及医患关系是其影响因素。医护人员应重视和提高患者疾病感知和对医疗决策知情程度,改善医患关系,采取个性化决策和辅助措施提升患者参与医疗决策的满意度。

Objective To investigate the satisfaction level of elderly patients who were about to receive a total knee arthroplasty by participation in the medical decision-making,and to analyze the influencing factors of it.Methods The convenience sampling method was used to recruit 244 patients undergoing total knee arthroplasty in Changsha between June 2011 and September 2011.The survey was carried out in a manner of five questionnaires including the general demographic data questionnaire,the satisfaction questionnaire of patients’participation in medical decision-making,the simple disease perception questionnaire,the questionnaire of patients’knowledge of medical decision-making and the doctor-patient relationship scale(PDRQ/DDPRQ scale).Results The satisfaction score of patients participating in medical decision-making was(77.90±11.51),at a middle level.The satisfaction of patients’participation in medical decision-making was positively correlated with the doctor-patient relationship and patients’knowledge of medical decision-making(r=0.971,0.678;both P<0.05),but negatively correlated with disease perception(r=-0.739,P<0.05).Multiple linear regression analysis showed that family income,education level,disease perception,patients’knowledge of medical decision-making,and doctor-patient relationship were the influencing factors of the satisfaction with the patient participation in the decision-making(P<0.05).Conclusions The satisfaction level of elderly patients undergoing total knee arthroplasty participating in medical decision-making is not high.Disease perception,patients’knowledge of medical decision-making and doctor-patient relationship are the major influencing factors.Attention should be paid to the medical staff in order to increase the disease perception and the knowledge of medical decision-making of the patient,improve the doctor-patient relationship,and enhance the patients’satisfaction with the participation in medical decision-making through personalised assistance measures.