中药注射剂抗肿瘤治疗的医患偏好及共同决策比较分析

目的 对中药注射剂抗肿瘤治疗的医患偏好及共同决策现状进行比较分析，为相关研究和临床实践提供参考。方法 于2020年10月—12月对上海市9家三级医院的肿瘤治疗相关科室的185名医生及347名住院肺癌患者开展问卷调查，通过离散选择实验调查医患对中药注射剂抗肿瘤治疗方案的偏好属性，并采用条件Logit模型及混合Logit模型对医患的偏好属性进行分析，采用医患共同决策测量工具对决策行为进行现状描述与比较分析。结果 医生更加关注恶心呕吐及其他毒副反应，患者更加关注疾病控制率及自付治疗费用。而在偏好差异的基础上，78.4%的医生以及90.2%的患者认为其参与的临床决策模式为共同决策模式。结论 医患之间的偏好属性及决策模式存在差异，并会在一定程度上影响患者满意度及和谐医患关系。建议激发医生医疗服务积极性，促进医患共同决策。

Comparative Analysis of Physicians' and Patients' Preference and Shared Decision Making of TCM Injection in Anti-tumor Therapy

ObjectiveTo comparatively analyze patients' and physicians' preferences and shared decision making for Traditional Chinese Medicine (TCM) injection treatment of anti-tumor so as to provide references for related research and clinical practice.MethodsFrom October to December 2020, a questionnaire survey was conducted among 185 doctors and 347 inpatients with lung cancer from tumor therapy-related departments of 9 tertiary hospitals in Shanghai. Discrete Choice Experiment (DCE) was conducted to investigate the preference attributes of doctors and patients for TCM injection in anti-tumor therapy. The conditional Logit model and mixed Logit model were used to analyze the preference attributes of doctors and patients, and the doctor-patient shared decision making assessment instrument was used to describe and compare the status quo of decision-making behavior. ResultsDoctors were more concerned about nausea, vomiting and other toxic side effects, and patients were more concerned about disease control rate and out-of-pocket cost for treatment. On the basis of preference differences, 78.4% of doctors and 90.2% of patients believed that the clinical decision-making mode they participated in was shared decision making mode.Conclusion Differences exist in attribute preference and decision-making mode between doctors and patients, which would affect patient satisfaction and harmonious doctor-patient relationship to a certain extent. It is suggested to stimulate the enthusiasm of doctors in medical services and promote shared decision making between doctors and patients.