医患共同决策模式对精神分裂症患者长效针剂治疗接受程度的影响

The influence of shared decision-making on the acceptance of long-acting injections in patients with schizophrenia

目的探讨医患共同决策模式(shared decision-making,SDM)在精神分裂症患者治疗方案抉择中的作用。方法在2020年7月1日—2020年12月31日在全国范围内进行一项网络调查,收集和评价医务人员采用SDM沟通模式对957例精神分裂症患者进行的医患沟通过程和效果,包括该沟通模式对患者和家属疾病知识、治疗策略及长效针剂治疗方案接受度的影响。结果采用SDM沟通后,精神分裂症患者和家属对诊疗信任度和参与度平均评分分别为(8.8±1.6)和(8.3±1.9)分,均得到显著提高;98.1%患者或家属完全或部分地接受了最为有效的治疗方案,与医护人员实施SDM的期待值相一致(P=0.094);对长效针剂充分了解和部分了解的比例分别为50.6%和46.1%,接受长效针剂治疗的比例达57.5%,显著高于既往水平。充分了解疾病和药物相关知识(OR=0.051,P=0.001)、大专及以上教育程度(OR=0.516,P=0.002)和家庭支持好(OR=0.549,P=0.003)对患方接受长效针剂治疗有促进作用,性别、疾病分期、躯体情况和依从性对是否接受长效针剂的影响无统计学显著性(P>0.05)。费用问题是患者和家属拒绝使用长效针剂较常见的原因。结论医患SDM能提高精神分裂症患者和家属对治疗的信任度和参与度,提高对长效针剂治疗方式的接受度。

Objective To explore the role of shared decision-making(SDM)in the choice of treatment options for patients with schizophrenia.Methods A nationwide network survey on the effectiveness of SDM was conducted from July 2020 to December 2020;404 doctors from 122 psychiatry centers of 25 provinces/municipalities participated the survey,and 957 schizophrenic patients were involved.The influence of SDM communication mode on the knowledge of disease,treatment strategy and acceptance of long-acting injection(LAI)treatment plan of patients or their family members was analyzed.Results After communication by using SDM,the average scores of trust and participation in diagnosis and treatment of schizophrenic patients and their families were(8.8±1.6)and(8.3±1.9)points,respectively;98.1%of the patients or their families received the most effective treatment plans completely or partially,which was consistent with the expectation of medical staff to implement SDM(P=0.094).The proportion of fully understanding and partial understanding of LAIs was 50.6%and 46.1%,and the proportion of patients receiving LAIs was 57.5%,which was significantly higher than the previous level.Full understanding of disease and drug(OR=0.051,P=0.001),college education or above(OR=0.516,P=0.002)and good family support(OR=0.549,P=0.003)were factors to promote patients acceptance of LAIs.The gender,disease stage,physical condition and compliance had no significant effects on the acceptance of LAIs(P>0.05).In addition,cost issue was a common reason of patients and families to refuse using LAIs.Conclusion The shared decision-making model can increase the trust and participation in treatment of schizophrenic patients and their families,and increase the acceptance of long-acting injection therapy.