急性缺血性脑卒中溶栓代理决策者决策心理特征聚类及影响因素研究

Characteristic clustering and factor analysis of thrombolytic agent decision making in acute ischemic stroke

目的探索急性缺血性脑卒中溶栓代理决策者不同决策心理特征的类别,并分析不同类别的影响因素,为制订溶栓决策辅助策略提供参考。方法便利选取2019年9月—2021年12月在河南省郑州市某综合性三级甲等医院急诊科就诊的急性缺血性脑卒中患者及其代理决策者为调查对象,采用一般资料问卷、决策参与期待量表、决策困境量表、维克森林医师信任量表在患者入院后48 h内收集调查对象的相关信息,使用误差平方和与轮廓系数确定最佳聚类簇数,采用K-means聚类分析完成最终聚类,通过无序多分类Logistic回归分析其影响因素。结果急性缺血性脑卒中溶栓代理决策者可分为“低信任—被动型—决策延迟”(9.1%)、“中等信任—合作型—决策冲突”(42.6%)、“非常信任—合作型—决策有效”(48.3%)3种类别,其影响因素包括决策者性别、参与决策人数(除代理决策者外)、决策者文化程度、决策者关于卒中知识的掌握程度、是否与患者同住、发病前患者月收入、美国国立卫生院神经功能缺损评分、患者发病时段(均P<0.05)。结论不同溶栓代理决策者的决策心理特征存在差异,医护人员应针对其心理特征提供个性化决策辅助措施,提高溶栓决策效率,加快溶栓知情同意进程,为挽救患者神经功能争取宝贵时机。

Objective To explore the categories of different decision-making psychological characteristics of thrombolytic agent decision makers in acute ischemic stroke and to analyze the influencing factors so as to provide reference for the development of thrombolytic decision aid strategies.Methods Acute ischemic stroke patients and their agent decision makers attending the emergency department of a comprehensive tertiary hospital in Zhengzhou City,Henan Province,from September 2019 to December 2021 were recruited as participants.General Information Questionnaire,Decision-making Participation Expectancy Scale,Decision Dilemma Scale,and the Wake Forest Physician Trust Scale were adopted to collect relevant information from participants within 48 hours of their admission.The optimal number of clusters was determined using sum of the squared errors and silhouette coefficients,the final clustering was completed using K-means cluster analysis,and the influencing factors were analyzed by unordered multicategorical logistic regression.Results Acute ischemic stroke thrombolytic agent decision makers were classified in to three types namely“low trust-passive-decision delay”(9.1%),“moderate trust-cooperative-decision conflict”(42.6%),and“very trust-cooperative-decision effective”(48.3%).Factors influencing the three categories included gender of the decision maker,number of decision makers,education level of decision makers,knowledge of the decision maker about stroke,whether the decision maker lived with the patient,patient’s income before the onset of stroke,NIHSS score,and time to onset of stroke(all P<0.05).Conclusion The psychological characteristics of decision makers differ among thrombolysis agents.Healthcare professionals should provide individualized decision aids to improve the efficiency of thrombolysis decision making,accelerate the process of informed consent for thrombolysis,and strive for valuable time to maintain patients’neurological function.