医患共同决策过程中医生行为潜在类别及其影响因素研究

Analysis of latent class and influencing factors of doctors′behaviors in doctor-patient shared decision-making

目的探索医患共同决策过程中医生行为的潜在类别,并分析其影响因素。方法使用便利抽样法,于2023年8—9月选取北京市东城区4所三级甲等医院的临床医生作为研究对象,使用一般资料调查表、共同决策问卷医生版、医患关系量表、杰弗逊共情量表、医师信任患者量表进行调查。根据共同决策问卷医生版各条目进行潜在剖面分析,采用有序logistic回归分析探索临床医生共同决策行为潜在类别的影响因素。结果共纳入480名临床医生。潜在剖面分析结果显示,临床医生共同决策行为可分为3个潜在类别,分别为共同决策缺失组(17.3%,83人)、共同权衡不足组(52.5%,252人)、共同决策充分组(30.2%,145人)。有序多分类logistic回归分析结果显示,职业发展机会(OR=0.509,P=0.038)、工作年限(OR=1.103,P=0.019)、共情能力(OR=1.096,P<0.001)与医患信任(OR=1.053,P<0.001)是临床医生共同决策行为的独立影响因素。结论医患共同决策过程中医生行为存在群体异质性,工作年限长、职业发展机会充足、共情能力高、医患信任程度高是其促进因素。未来可以此为靶点,从医院管理者与临床医生两个角度,规划改善提升方案。

ObjectiveTo explore the latent classes of doctors′behaviors in the process of shared decision-making between doctors and patients,and analyze the influencing factors for the latent classes.MethodsFrom August to September 2023,doctors from 4 tertiary hospitals in Dongcheng district,Beijing were selected using convenience sampling method.The general information questionnaire,shared decision making questionnaire-physician version(SDM-Q-Doc),doctor patient relationship questionnaire,the Jefferson scale of empathy health professionals,physician trust in the patient scale were administered to the participants.Latent profile analysis was performed based on the items of SDM-Q-Doc.The ordinal logistic regression analysis was conducted to explore the influencing factors of the latent classes of shared decision making.ResultsA total of 480 doctors were included in the study.The results of latent profile analysis showed that doctors could be classified into 3 subgroups by shared decision making,namely shared decision missing group(17.3%,83/480),collective balance deficiency group(52.5%,252/480),and shared decision making group(30.2%,145/480).The results of ordinal logistic regression analysis showed that career development opportunity(OR=0.509,95%CI:0.269-0.965,P=0.038),working years(OR=1.103,95%CI:1.016-1.196,P=0.019),empathic ability(OR=1.096,95%CI:1.079-1.113,P<0.001)and doctor-patient trust(OR=1.053,95%CI:1.027-1.080,P<0.001)were independent influencing factors of doctors′shared decision making.ConclusionsThe shared decision making of doctors showed significant population heterogeneity.Longer working years,sufficient career opportunities,high empathy ability and strong doctor-patient trust could enhance shared decision making behavior of the doctors.Intervention can be planned based on above factors from the perspectives of hospital managers and doctors in the future.