肾脏替代治疗的终末期肾脏病患者参与医患共享决策的现状及影响因素分析

Participation status and influencing factors of doctor-patient shared decision-making in patients with end-stage renal disease treated by renal replacement therapy

目的:分析采用肾脏替代治疗的终末期肾脏病患者参与医患共享决策的现状及影响因素。方法:回顾性分析2021年5月至2021年8月该院收治的286例采用肾脏替代治疗的终末期肾脏病患者的临床资料,采用调查问卷及决策倾向量表调查其参与决策的现状,进行单因素及Logistic回归分析。结果:286例终末期肾脏病患者中,治疗决策期待参与方式以共享型为主,占54.20%;实际参与方式以非共享型为主,占76.22%。单因素分析结果显示,性别、年龄、付费方式、子女数、病程与终末期肾脏病患者共享决策实际参与方式存在明显相关性(P<0.05);Logistic回归分析结果显示,女性、年龄<40岁、付费方式为全额报销、子女数>2个、病程短为终末期肾脏病患者参与共享决策的积极因素(OR>1,P<0.05)。结论:女性、年龄<40岁、付费方式为全额报销、子女数>2个、病程短为终末期肾脏病患者参与共享决策的积极因素,而男性、年龄≥40岁、报销比例低、子女数少、病程长为终末期肾脏病患者参与共享决策的消极因素,临床针对消极患者应加强健康教育,告知各治疗方式的优劣,征求其意见,以提高患者医患共享决策参与率。

Objective:To analysis participation status and influencing factors of doctor-patient shared decision-making in patients with end-stage renal disease treated by renal replacement therapy.Methods:The clinical data of 286 patients with end-stage renal disease treated by renal replacement therapy in this hospital from May to August 2021 were retrospectively analyzed.A questionnaire and a decision-making tendency scale were used to investigate the status of their participation in the decision-making.Further,the univariate and Logistic regression analysis were used to analyze the influencing factors.Results:Among the 286 patients with end-stage renal disease,54.20% expected to participate the treatment decision-making in shared form,while 76.22% wanted to take the unshared form.The univariate analysis showed that the gender,age,payment method,number of children,and disease duration were significantly correlated with their actual participation ways in the shared decision-making(P<0.05).Logistic regression analysis showed that female,age <40 years old,full reimbursement,number of children >2,and short course of disease were the positive factors for these patients to participate in the shared decision-making(OR>1,P<0.05).Conclusions:Female,age <40 years old,full reimbursement,number of children >2,and short course of disease are the positive factors for the patients to participate in the shared decisionmaking,while male,age ≥40 years old,low reimbursement ratio,small number of children,and long course of disease are the negative factors.For the inactive patients,health education should be strengthened,the advantages and disadvantages of each treatment method are informed,and the patients’ opinions are sought so as to increase the participation rate of the patients in doctor-patient shared decision-making.