药物涂层支架技术临床应用中的患者参与决策研究

目的:研究药物涂层支架技术临床应用中的患者参与决策现况,分析患者在治疗决策中的参与及其对患者技术使用行为的影响,为相关理论研究和临床实践提供参考。方法:采用横断面设计和多阶段分层抽样方法,选取上海市、福建省、四川省医院心内科冠心病患者进行问卷调查。结果:冠心病患者参与决策量表总得分为32.93±8.235,聚类分析显示92位(61.33%)患者量表得分为"较高";患者量表得分对患者治疗技术选择有显著影响(P0.05),对患者决策满意度有显著影响(P0.05),患者决策满意度对患者治疗技术选择也有显著影响(P0.05),此三者间两两相关。结论:冠心病患者多偏好医患共同决策,但其参与决策的实际程度仍有待提高;患者参与决策正向影响冠心病患者决策满意度,并影响患者是否选择应用药物支架;应当鼓励医患共同决策模式,提升患者满意度并改善医患关系;建议加强技术全方位监督管理,促进药物支架技术的适宜推广。

Patients participation in decision-making during the clinical application of drug-eluting stents in China

Objectives:To study the current situation of patients'' participating in decision-making during the clinical application of drug-eluting stents (DES), to analyze the impact of their involvement in decision-making on adoption and/or technical use of DES, and to provide reference for relevant theoretical research and clinical practice. Methods:The cross-sectional design and multi-stage stratified sampling method were used, and a survey was conducted on patients with coronary heart disease from cardiology departments in 15 hospitals in Shanghai, Fujian and Sichuan. A survey questionnaire was developed independently with reference to SDM-Q-9 scale, and data analysis was conducted using LIKERT methods, clustering analysis and logistic regression. Results:The total SDM-Q-9 score of those with coronary heart disease participating in the decision-making was 32.93±8.235, and the cluster analysis showed that patients score was "higher", being 92 (equivalent of 61.33%). The SDM-Q-9 score had significant impact on patient''s adoption and/or technical use of DES (P<0.05) and on patient satisfaction (P<0.05), while patient''s satisfaction also influenced patients'' adoption of DES (P<0.05), and the three were correlated. Conclusions:Most of the coronary heart disease patients preferred the shared doctor-patient decision-making, and their actual degree of involvement needs to be improved. Patients'' participation in decision-making positively affects the satisfaction of those suffering from coronary heart disease and has direct or maybe indirect impact on patients'' adoption of DES. It is suggested to encourage patients'' involvement in decision-making and strengthen the supervision and management for DES in order to improve the satisfaction degree and doctor-patient relationship, and promote the appropriate promotion of drug stent technology.