稳定性冠心病诊疗中患者参与临床决策质量及其影响因素

Quality and influencing factors of patient involvement in clinical decision⁃making in diagnosis and treatment of stable coronary artery disease

目的 了解在稳定性冠心病(SCAD)的诊疗中,患者参与临床决策质量和决策偏好,并分析决策质量的影响因素。方法 用便利抽样的方法,在阜外医院住院患者中抽取126例患者,调查患者的决策质量和决策偏好。利用单因素分析和二元Logistic回归分析患者决策质量的影响因素。结果 126例患者中,医疗决策偏好患者主导型50(39.7%)例,共同决策型26(20.6%)例,医生主导型50(39.7%)例,决策质量平均得分为81.39。单因素分析显示患者的家庭年收入、治疗满意程度和决策偏好是决策质量的影响因素(P<0.05)。Logistic回归分析发现,治疗满意程度高(OR=6.722,95%CI:2.635~17.148)、共同决策偏好(OR=5.152,95%CI:1.477~17.975)的患者决策质量更高。结论 在SCAD的诊疗中,从患者层面而言,合作型的决策偏好会提高决策质量,并提高治疗满意度。患者本身的因素不会影响决策质量,提升决策质量需要从医生和医院入手。

Objective To investigate the quality of patient participation in clinical decision-making and the decision preference of patients in the diagnosis and treatment of stable coronary artery disease(SCAD)and to analyze the influencing factors of decision quality. Methods A total of 126 inpatients in Fuwai Hospital were selected by convenience sampling to investigate their decision quality and decision preference. Univariate analysis and binary logistic regression were used to analyze the influencing factors of decision quality. Results Among 126 patients, 50(39.7%) were active, 26(20.6%) were shared and 50(39.7%) were not active. The average score of decision quality was 81.39. Univariate analysis showed that annual household income, treatment satisfaction and decision preference were the influencing factors of decision quality(P<0.05). Logistic regression analysis showed that patients with high treatment satisfaction(OR=6.722, 95% CI:2.635-17.148) and shared decision preference(OR=5.152, 95% CI:1.477-17.975) had higher decision quality. Conclusions In the diagnosis and treatment of SCAD, shared decision preference can improve decision quality and improve satisfaction. The characteristics of patients are not related to decision quality. To improve the decision quality needs to start with doctors and hospital.