臺灣博碩士論文加值系統

近年來由於醫療糾紛不斷發生甚且日益嚴重，醫病關係愈趨惡化緊張，造成許多急重症醫護人力的流失。然而大部分的醫療糾紛是可以經由加強醫病溝通而事先預防的。有效的醫病溝通對於建立良好醫病關係、改善醫療遵從度、增加病人滿意度都有正向的價值。但是醫病溝通之後醫師及病人雙方仍存在對醫療照護認知上的差異，這樣認知的差異會導致醫療期望的落差、醫療品質的降低、病人安全的疑慮及醫療糾紛的產生。因此本研究目的在探討病人住院期間與醫師在照護溝通上認知差異的面向與程度。藉由發現醫病雙方在溝通上認知的差異，尋找合適的方法加以補救，是「以病人為中心」的醫療照護實務上極為重要的課題。
本研究採橫斷面問卷調查的方式，對中部某區域教學醫院20歲以上內、外科系的出院病人，測量病人對醫病互動的認知。再以相同的問題組成醫師問卷，測量主治醫師對醫病互動的認知。
本研究共收集132位病人問卷及132份主治醫師問卷，以病人及醫師配對方式，比較病人和醫師對於醫病互動認知的差異。同時分析病人中不同年齡、性別、教育程度、婚姻狀況，和主治醫師不同科別、不同執業年資對於醫病溝通認知的差異。問卷資料以SPSS軟體進行資料處理及統計分析。
研究結果顯示，病人住院期間主治醫師與病人在資訊的傳達、互動的感受及醫療決策的參與方面，醫師與病人之間都存在有統計學上明顯的認知差異，而且醫師在各題項的平均分數均低於病人的分數。特別是在病人是否希望更多參與醫療決策認知方面，醫師的認知明顯低於病人的期望。

病人與醫師對於醫療照護過程中的認知差異，是一項重要且值得討論的議題。若是醫師缺乏對於醫病認知差異的了解及警覺，將會降低提供安全、有效、公平、以病人為中心的醫療水平，並增加醫療糾紛的風險。

In recent years, as medical disputes have continued to occur with increased frequency and severity, doctor-patient relationships have also deteriorated, resulting in the gradual loss of critical care health care professionals. However, most medical disputes can be prevented by strengthening communication between doctors and patients. Effective communication has the positive value of establishing good doctor-patient relationships, improving medical compliance, and increasing the overall level of patient satisfaction. However, it is not uncommon for doctors and patients to hold different perceptions and opinions even after the communication process. These differences in perception can lead to a discrepancy in medical expectations, a decline in the quality of medical care, skepticism with regards to patient safety, and the occurrence of medical disputes. The purpose of this study is to investigate various aspects and levels of differences perceived by doctors and patients for the duration of hospital stay. In order to develop effective “patient-centered” medical care practice, it is vital to examine the differences in perception experienced by doctors and patients during their communication process, and to find effective solutions that can help remedy various situations.
In this study, a cross-sectional questionnaire was given to discharged patients over 20 years old from both the internal medicine and surgical departments in a teaching hospital in central Taiwan, with the aim to assess the patient’s perception of the interaction between doctors and patients. A questionnaire containing the same set of questions was then given to the patients’ attending physicians to assess the doctor’s perception of the interaction between doctors and patients.
A total of 132 patient questionnaires and 132 attending doctor questionnaires were collected. Doctor-patient pairing methods were used to compare the differences in perception in the interaction between doctors and patients. At the same time, factors such as the patient’s age, gender, education level, marital status, and the attending doctor’s specialization and duration of practice were also analyzed to account for differences in perception between the doctor and the patient. The data in the questionnaire was processed and statistical analysis was conducted by SPSS software.
The results of the study show that there are statistically significant differences in perception between doctors and patients with regards to the transmission of information, mutual interaction, and participation in decision-making during hospitalization. The average scores obtained by doctors in each category are lower than those obtained by the patients. Particularly, in terms of whether the patient wants to be more involved in the medical decision-making process, the doctor''s perception is significantly lower than the patient''s expectation.
The differences in perception between patients and doctors during the process of medical care are important and worthy of further discussion. If the doctor lacks understanding and awareness of the differences in perception between doctors and patients, this would reduce the hospital’s ability to provide patient-centered medical care, and thereafter increase the risks of medical disputes.

目錄
第一章　緒論
第一節　研究背景與動機 1
第二節　研究目的 4
第二章　文獻探討
第一節 醫病關係 5
第二節 醫病溝通 7
第三節 醫病共享決策 10
第四節 住院經驗問卷 13
第五節 文獻小結 16
第三章　研究方法
第一節　研究架構 17
第二節　研究假設 18
第三節　研究對象與資料收集 19
第四節　研究工具 20
第五節　分析方法 25
第四章　研究結果
第一節　預試 26
第二節　描述性統計 33
第三節　病人與醫師溝通認知之獨立統計 42
第四節　醫師與病人溝通認知之獨立統計 53
第五節　病人與醫師溝通認知差異之配對統計 60
第五章　討論 67
第六章　結論與建議
第一節　結論 71
第二節　建議 73
第三節 研究限制 74
參考文獻
中文部分 75
英文部分 76
附錄
附錄 1 HCAHPS問卷 80
附錄 2病人問卷 85
附錄 3醫師問卷 88
附錄 4 IRB審查同意證明書 91

表目錄
表 2-2 PPE-15問卷………………………………………………...13
表 3-1 研究變項操作型定義..............................................................22
表 4-1-1 項目分析 27
表 4-1-2 因素分析-預試(一) KMO與BARTLETT檢定 28
表 4-1-3 因素分析-預試(二) 成份矩陣 29
表 4-1-4因素分析-後測(一) KMO與BARTLETT檢定 29
表 4-1-5因素分析-後測(二) 成份矩陣 30
表 4-1-6信度分析 31
表 4-2-1受訪病人及醫師基本資料之描述性統計分析 35
表 4-2-2 病人是否知道主治醫師姓名與主治醫師認知比較 37
表 4-2-3 病人是否知道住院診斷與主治醫師認知比較 37
表4-2-4 病人問卷第3-9題之描述性統計分析 39
表 4-2-5 醫師問卷第3-9題之描述性統計分析 41
表 4-3-1 病人組溝通認知與性別之統計差異 42
表 4-3-2 病人組溝通認知與婚姻狀況之統計差異 43
表 4-3-3 病人組溝通認知與年齡之統計差異 44
表 4-3-4 病人組溝通認知與疾病嚴重度之統計差異 45
表 4-3-5 病人組溝通認知與之前是否曾住院之統計差異 46
表 4-3-6 病人組溝通認知與教育程度之統計差異 47
表 4-3-7 病人組溝通認知與不同主治醫師年資之統計差異 48
表 4-3-8 病人組溝通認知與住院科別之統計差異 50
表 4-3-9 病人組溝通認知與住院途徑(門診、急診)之統計差異 52
表 4-4-1 醫師組內、外科系醫師與病人溝通認知之統計差異 53
表 4-4-2 醫師組不同年資醫師與病人溝通認知之統計差異 54
表 4-4-3 醫師組與不同疾病嚴重度病人溝通認知之統計差異 55
表 4-4-4 醫師組醫師與不同年齡病人溝通認知之統計差異 56
表 4-4-5 醫師組醫師與不同教育程度病人溝通認知之統計差異 57
表 4-4-6 醫師組醫師與不同住院途徑病人溝通認知之統計差異 58
表 4-5-1 病人與醫師溝通認知之差異:是否知道主治醫師姓名 60
表 4-5-2 病人與醫師溝通認知之差異:是否知道住院的診斷 61
表 4-5-3 醫師與病人溝通認知差異之配對統計 63

圖目錄
圖 2-1醫病共享決策之執行步驟11
圖 3-1 研究架構 17
圖 4-5 醫師與病人溝通認知差異 65

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