急诊危重症患者替代决策者参与医疗决策期望现状及影响因素分析

Status and influencing factors of expectation of decision-makers participation in medical decision-making for emergency critically ill patients substitution

目的了解急诊危重症患者替代决策者参与医疗决策期望现状及影响因素,为改善急诊危重症患者及家属就医体验,提升其医疗决策参与能力提供参考。方法采用便利抽样法,选取2022年10月至2023年6月在广西某三级甲等医院急诊科参与替代决策的226名危重症患者家属为研究对象,通过问卷调查一般资料、应对方式以及决策倾向性,分析其参与医疗决策期望现状及影响因素。结果急诊危重症患者替代决策者参与医疗决策期望的总分为(50.10±5.10)分;Pearson相关性分析显示,急诊危重症患者替代决策者参医疗决策期望总分与积极应对呈正相关,与消极应对呈负相关(P<0.05);多元线性回归分析显示,替代决策者文化程度、与患者的关系、患者疾病种类以及是否理解医生的病情谈话内容均是急诊危重症患者替代决策者参与医疗决策期望的影响因素(均P<0.05)。结论急诊危重症患者替代决策者参与医疗决策期望较高且受多种因素影响,文化程度较高、患者子女、急性病就诊患者、理解医生的病情谈话内容的替代决策者参与医疗决策期望更高,采用个性化的决策辅助方案能够帮助医护人员改善其决策参与意愿,提高决策质量。

Objective To understand the current situation and influencing factors of the expectation of alternative decision-makers for emergency critically ill patients to participate in medical decision-making,providing reference for improving the medical experience of emergency critically ill patients and their families,and enhancing their ability to participate in medical decision-making.Methods A convenience sampling method was employed to select 226 family members of emergency critically ill patients in a tertiary grade A hospital in Guangxi from October 2022 to June 2023 as the subjects of the study.Analyze the current situation and influencing factors of their participation in medical decision-making expectations through a questionnaire survey on general information,coping strategies,and decision-making tendencies.The general information questionnaire,Decision-making tendency and Simple coping styles were used for survey.Results The total score of expectation of decision-makers participation in medical decision-making was(50.10±5.10).Pearson correlation analysis showed that the expectation of decision-makers participation was positively correlated with positive coping styles and negatively correlated with negative coping styles(P<0.05).Multiple linear regression analysis showed that education level,relationship with patients,disease types and understanding doctor's consultation content were influencing factors of expectation of participation in medical decision-making(P<0.05).Conclusion The expectation of decision-makers participation in medical decision-making is high,and are influenced by multiplc factors.The high level of emergency critically ill patients substitution with high education level,offspring position,acute diseases and understanding about doctor's consultation content have a high expectation of decision-makers participation in medical decision-making.Personalized decision assistance can help medical staffs improve willingness of decision-making participation and quality of decision-making.