医生对医患共享决策认知的质性研究

doi:10.12114/j.issn.1007-9572.2021.00.254

摘要/Abstract

摘要： 背景医患共享决策推动了患者角色从医疗照护的被动接受者向主动参与者和监督者的转变，深度贯彻了"以患者为中心"的理念。国内对医患共享决策的研究尚处于起步阶段，作为决策的主体之一，医生对医患共享决策认知的相关研究比较少。目的探索医生对医患共享决策的认知情况，为医患共享决策的实施提供依据。方法2020年5—7月，采用方便抽样法，对15名上海市某三级甲等医院的医生进行半结构式访谈，访谈内容包括医生实际的决策过程、医生对医患共享决策的理解及态度、医患共享决策实践中存在的阻碍因素，并采用Colaizzi七步分析法对访谈资料进行分析。结果15名被访谈医生中，男10名，女5名；年龄28~53岁，平均年龄（38.4±7.0）岁；住院医师4名，主治医师5名，副主任医师4名，主任医师2名；内科医生5名，外科医生7名，肿瘤科医生3名。共提炼出15个亚主题，可归纳为4个主题：医生对医患共享决策的认知偏差，对医患共享决策实施中的角色认知不明确，医生认同医患共享决策具有重要意义,医患共享决策实践存在阻碍因素。结论需提高医生对医患共享决策的认知水平，并创造临床实施医患共享决策的条件，以促进医患共享决策在临床的顺利开展。

关键词: 共同决策, 认知, 质性研究

Abstract: Background

Shared decision-making has promoted the transformation of the role of patients from passive recipients of health care to active participants and supervisors, deeply reflecting the idea of patient-centered care. Research on shared decision-making in China is still in its infancy. Physicians are major participants in decision-making, but their perspectives on shared decision-making have been rarely studied.

Objective

To explore physicians' perspective on shared decision-making, offering evidence for the implementation of shared decision-making.

Methods

From May to July 2020, we conducted semi-structured interviews with 15 physicians selected by convenience sampling method from a grade A tertiary hospital in Shanghai for investigating their actual decision-making process, their views and attitudes about shared decision-making, and the obstacles to clinical implementation of shared decision-making. The interview results were analyzed by Colaizzi's method of data analysis.

Results

Among the 15 physicians, 10 were male and 5 were female; aged 28-53 years old, with an average age of (38.4±7.0) years old; 4 residents, 5 attending physicians, 4 associate chief physicians, and 2 chief physicians; 5 physicians, 7 surgeons and 3 oncologists. Four themes including 15 subthemes were identified: differences in physicians thederstanding of policies related to shared decision-making; unclear understanding of physicians and patients' roles in shared decision-making; acknowledging the importance of shared decision-making; obstacles to clinical implementation of shared decision-making.

Conclusion

Our study suggests that improving physicians' understanding level of shared decision-making, and creating conditions facilitating clinical implementation of shared decision-making may promote the sound development of shared decision-making.

Key words: Decision making, shared, Cognition, Qualitative research

中图分类号:

R395

杨林宁,郑红颖,赵丹,等. 医生对医患共享决策认知的质性研究[J]. 中国全科医学, 2022, 25(10): 1213-1219. DOI: 10.12114/j.issn.1007-9572.2021.00.254.

YANG Linning, ZHENG Hongying, ZHAO Dan, YANG Yan.

Physicians' Perspective on Shared Decision-making：a Qualitative Study [J]. Chinese General Practice, 2022, 25(10): 1213-1219.

图/表 1

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