家长医患沟通效能对孤独症谱系障碍儿童康复效果的影响

Impact of parental efficacy in doctor-patient communication on rehabilitation outcomes for children with autism spectrum disorder

目的从家长医患沟通效能的视角,探究针对孤独症谱系障碍(ASD)儿童康复效果的潜在影响因素及其复杂作用路径,为提升ASD儿童的康复服务质量提供依据。方法采用面对面匿名问卷调查的方式,收集甘肃省儿童康复定点机构ASD儿童家长的一般信息、家长医患沟通效能、家长治疗依从性、儿童康复效果等相关资料,应用结构方程模型探索家长医患沟通效能对ASD儿童康复效果的影响机制。结果共收集甘肃省13个市/州37家儿童康复机构的ASD儿童家长519名,家长医患沟通效能、医患关系、家长治疗依从性和ASD儿童康复效果两两之间均呈正相关(P<0.05);结构方程模型分析结果为:家长医患沟通效能对ASD儿童康复效果的标准化直接效应值为0.151(P=0.023),医患关系、家长治疗依从性的中介效应值分别为0.160(P=0.001)、0.111(P=0.001),医患关系和家长治疗依从性的链式中介效应值为0.035(P=0.001),“家长医患沟通效能→医患关系→ASD儿童康复效果”占总中介效应的比例最高,为52.29%。结论家长医患沟通效能可直接及间接通过医患关系和家长治疗依从性对ASD儿童康复效果发挥积极作用。康复机构应注重家长医患沟通效能的培养,加强高质量及人性化的康复服务。

Objective To explore the potential influencing factors and complex pathways affecting rehabilitation effect for children with autism spectrum disorder(ASD)from the perspective of parental efficacy in doctor-patient communication,and to provide evidence for improving the quality of rehabilitation service for children with ASD.Methods An anonymous face-to-face questionnaire survey was conducted to collect general demographic information of parents of children with ASD at designated rehabilitation institutions in Gansu province.The data included parental efficacy in doctor-patient communication,parental compliance of treatment and children's rehabilitation outcomes were collected.A structural equation model was used to explore the impact mechanism of parental communication efficacy on the rehabilitation outcomes of children with ASD.Results Data from 519 parents at 37 rehabilitation institutions across 13 cities/counties in Gansu province were collected.Significant positive correlations were found between parental efficacy in doctor-patient communication,doctor-patient relationships,parental compliance with treatment and rehabilitation outcomes for children with ASD(P<0.05).Through structural equation model analysis,the standardized direct effect of children with ASD from parents'doctor-patient communication efficacy was 0.151(P=0.023).The mediating effect of doctor-patient relationship and parental compliance with treatment were 0.160(P=0.001)and 0.111(P=0.001),respectively,with a chained mediating effect of 0.035(P=0.001).The pathway"parental efficacy in doctor-patient communication→doctor-patient relationship→ASD child's rehabilitation outcome"accounted for the highest proportion of the total mediating effect,at 52.29%.Conclusion Parental doctor-patient communication efficacy may positively impact on the rehabilitation outcomes of children with ASD directly,and indirectly through the doctor-patient relationship and parental compliance with treatment.Rehabilitation institutions should focus on fostering parental communication skills and enhancing high quality and humanized rehabilitation services.