心血管疾病患者参与临床决策倾向性的影响因素研究

摘要

目的 分析影响心血管疾病患者参与临床决策倾向性的因素.方法 抽取符合入选标准的心血管疾病患者258例,采用问卷调查方法,对患者的就医过程及对其临床决策倾向性的影响进行探讨.问卷调查的具体内容包括:①一般人口学资料;②疾病状况;③患者心理健康状况评估;④患者参与临床决策的意愿.结果 患者平均年龄(64±13)岁;男性占55.8%(144/258),女性占44.2%(114/258);88.0%(227/258)的患者可以报销医疗费用;82.2%的患者家庭月收入≥3 000元;89例(34.5%)患者在做临床决策时倾向于"医生根据医学知识做出决策",61例(23.7%)患者在做临床决策时倾向于"医生在询问患者需求后做出决策",94例(36.4%)患者倾向于"和医生共同做出决策",14例(5.4%)患者倾向于"和医生讨论后自己做出决策".无患者依据自己的知识独立做出决策.患者对医生的信任评分:最低7分,最高10分,平均(9.7±0.5)分;文化程度(OR=4.052,95%CI:1.800～9.126)是患者和医生做出共同决策的危险因素,对医生的信任评分(OR=0.071,95%CI:0.016～0.309)是患者和医生做出共同决策的保护因素.结论 心血管疾病患者对医生的信任度很高,患者的临床决策倾向性主要取决于患者对医生的信任程度.%Objective To analyze the influence factors of clinical decision making in patients with cardiovascular disease. Methods Totally 258 patients with cardiovascular disease were selected; the treatment process of patients and rnits effect on clinical decision preference were discussed by questionnaire investigation. The specific content of questionnaire included: ①general demographic data; ②the disease status; ③assessment of mental health status for patients; ④the willingness of clinical decision making participating in patients. Results The average age of patients was (64±13) years; there were 55.8%(144/258)of males, 44.2%(114/258)of female; 88.0%(227/258) of the patients could be reimbursed for medical expenses; 82.2% of the patients family monthly income was more than 3 000 Yuan. 89 patients(34.5%) in the clinical decisions tend to "decision-making" according to medical knowledge, 61 patients(23.7%) in the clinical decisions tend to "doctors make the decision" in asking the patient needs, 94 patients(36.4%) tend to "and the doctor decision-making", 14 patients(5.4%) and doctors tend to "after the discussion to make the decision by yourself". No patients based on their knowledge for independent decisions. The confidence for doctor: the minimum was 7 points, the highest score was 10 points, the average score of trust doctors in patients was (9.7± 0.5) points; Education level (OR=4.052,95%CI=1.800-9.126) was a risk factor for patients. The score for doctor's trust (OR=0.071,95%CI=0.016-0.309) were protective factors for make joint decisions between patients and doctors. Conclusion Patients with cardiovascular disease is high on the doctor's degree of trust, clinical decision-making preference mainly depends on the trust of patients on doctors.