摘要
背景医患共享决策是“以患者为中心”的重要体现形式之一,其临床实施过程并不理想,医生是推进医患共享决策实施过程的主体之一,但目前鲜见对共享决策过程中医生行为的研究。目的探讨医生参与医患共享决策的过程及主要的行为特征,为医患共享决策在临床的推广和应用提供依据。方法采用混合方法研究的聚敛式设计,同时收集定量数据和定性数据。定量研究采用方便抽样法,于2020年5—12月选取上海市某三级甲等医院的在职临床医生360例进行问卷调查,探索医生参与共享决策的现况,并对医生参与共享决策的行为进行K-均值聚类,分析医生共享决策行为的分布特征;定性研究采用方便抽样和目的抽样法,于2020年6—12月选取定量研究中的23例医生进行半结构式访谈,探索医生参与共享决策的过程和体验,明确医生在决策各环节的主要行为特征。结果定量研究结果:325例(90.3%)医生的问卷被有效回收,参与共享决策行为的平均得分为(80.44±14.88)分。医生在解释治疗方案优缺点[(4.38±0.74)分]、提供多种治疗方案[(4.30±0.84)分]两项行为上的参与度较高,在告诉患者需要共同做一个重要的决定[(3.72±1.22)分]、共同决定选择某一治疗方案[(3.74±1.03)分]两项行为上的参与度较低;聚类分析结果显示,医生参与共享决策的行为特征可分为3组,分别为“知情同意组”“患者部分参与组”“共享决策组”。定性研究结果:医患共享决策过程中医生的参与行为包括创建决策意识,提供信息,检查患者对信息的理解,澄清患者价值观,共同权衡(治疗方案的评价),决策制定与实施。混合研究结果:在决策进程中,医生更关注信息的提供,忽视了医患沟通层面促进患者参与的行为要素,医生参与共享决策的各行为特征不同。结论医患共享决策的行为是有限实施的,医生对共享决策的行为过程存
Background Shared decision-making is a practice that fully reflects the idea of patient-centered care,but its clinical implementation process is not ideal. Physicians are main participants to promote the implementation of shared decision-making,but there are few studies on their behaviors in shared decision-making. Objective To explore the process and main behavioral characteristics of physicians’ participation in shared decision-making,offering evidence for the promotion and implementation of shared decision-making in clinical practice. Methods A mixed-methods convergent design was used to collect quantitative and qualitative data. In the quantitative study,convenience sampling method was used to select inservice physicians(n=360) from a grade A tertiary hospital in Shanghai to attend a questionnaire survey from May to December 2020 to understand the status of their participation in shared decision-making. K-means clustering was conducted to analyze the distribution characteristics of physicians’ participation in shared decision-making. In the qualitative study,23 physicians selected from the participants of the quantitative study using convenience sampling and purposive sampling from June to December 2020 were recruited to attend semi-structured interviews to explore the process and experience of their participation in shared decision-making and identify the main behavioral characteristics of them in each part of the process of shared decision-making.Results Quantitative data analysis:in all,325(90.3%) of the physicians who returned responsive questionaries were included for analysis. The average total score of their participation behavior in shared decision-making was(80.44±14.88). The further analysis found that physicians had the highest participation in behaviors of "Explain the advantages and disadvantages of the treatment options to my patient"(4.38±0.74) and "I told my patient that there are different options for treating his/her medical condition"(4.30±0.84);physicians had the lowest participatio
作者
杨林宁
郑红颖
徐于睿
杨艳
YANG Linning;ZHENG Hongying;XU Yurui;YANG Yan(Department of Nursing,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;School of Public Health,Fudan University,Shanghai 200032,China;Shanghai Jiao Tong University School of Nursing,Shanghai 200025,China)
出处
《中国全科医学》
CAS
北大核心
2023年第7期843-852,共10页
Chinese General Practice
基金
上海交通大学护理高原学科建设国际合作基金(Hlgy1802gj)。
关键词
共同决策
医生病人关系
行为特征
混合研究
Decision making
shared
Physician-patient relations
Behavior characteristics
Mixed-method study
