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研究生:張芷瑜
研究生(外文):Chih-Yu Chang
論文名稱:醫病共享決策下退化性關節炎患者的角色偏好及決策滿意度之相關因素探討
論文名稱(外文):Patient’s participation role and decision satisfaction in shared decision making among patients with knee osteoarthritis.
指導教授:王中儀王中儀引用關係
指導教授(外文):Jong-Yi Wang
學位類別:碩士
校院名稱:中國醫藥大學
系所名稱:醫務管理學系碩士班
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2018
畢業學年度:106
語文別:中文
論文頁數:64
中文關鍵詞:以病人為中心醫病共享決策角色偏好決策滿意度
外文關鍵詞:Patient-centered careShared decision makingPatient’s participation roleDecision satisfaction
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研究目的:近年來「醫病共享決策」是一個熱門的名詞,共享決策被稱是以病人為中心的照護關鍵。本研究欲探討台灣退化性膝關節炎病人參與治療決策的角色偏好、共享決策參與程度和決策滿意度,進一步研究決策的角色偏好對共享決策參與程度之影響以及共享決策參與程度與治療決策滿意度之相關性。
研究方法:本研究屬橫斷性研究,採初級資料分析。研究對象為50歲以上罹患退化性膝關節炎的病人。以結構式問卷收集人口學特徵、醫病互動角色偏好、共享決策參與程度和決策滿意度。針對南部某區域教學醫院採便利抽樣進行調查,發放250份問卷,回收199份有效問卷,回收率為79.6%。
研究結果:本研究以女性較多,平均年齡為66.6歲,平均罹病時間為50.7個月,而自覺疼痛程度平均分數為6.2分(滿分10分)。調查退化性膝關節炎患者在醫療決策中的期望角色偏好以被動角色最多(47.7%),其次為合作角色(34.2%),主動角色最少(18.1%);大部分病人的期望與實際參與角色相符。而多數變項與病人的醫病互動角色偏好、決策共享程度和決策滿意度沒有顯著相關。同樣病人的角色偏好在共享決策程度沒有呈統計上顯著差異。惟共享決策程度與決策滿意度之間具有線性關係,且兩者呈現高度正相關。
結論:沒有特定因子能預測病人的角色偏好,雖然一開始病人期待採被動角色,但在實際就診過程中,病人了解疾病的所有治療方式後,仍會主動參與決策。而病人的共享決策程度越高,其決策滿意度會越高。建議未來臨床人員多鼓勵病人及其家屬參與治療決策。
Objective: Recently, "Shared Decision Making" is a popular noun and it was considered the key of patient-centered care. The purpose of this study was to investigate role preferences, perceived involvement and decision satisfaction of patients with knee osteoarthritis in treatment decision-making. Further, we examined the influence of patient’s participation role on sharing decision making and the relationship between shared decision-making (SDM) and satisfaction with decision (SWD)
Methods: This is a cross-sectional study using primary data analysis. A purposive sampling of knee osteoarthritis patients with age 50 years at least. Demographic characteristics, shared decision making and decision satisfaction were collected with structured questionnaire. Convenient sampling was from one southern regional teaching hospital. There were 250 samplings issued and collecting 199 valid questionnaire. The effective response rate was 79.6%.
Results: There were more female than male, and the average age is 66.6 years. The average score of perceived pain was 6.2 points (out of 10 points). The expected role preference of patients with degenerative knee osteoarthritis in decision making was the most passive role (47.7%), followed by the cooperative role (34.2%), and the least active role (18.1%); the expectation and actual participation of most patients Match. However, most of the variables were not significantly related to the patient''s interaction role preference, decision-sharing and decision-making satisfaction. The same patient''s role preference did not show a statistically significant difference in the share of decision-making. However, there is a linear relationship between the sharing decision-making degree and the satisfaction of the decision, and the two are highly positively correlated.
Conclusion: There is no specific factor that can predict the patient''s role preference. Although the patient initially expects to adopt a passive role, in the actual treatment process, after the patients understand all the treatment methods of the disease, they will actively participate in the decision. We find if the degree of sharing decision of patient is higher, the satisfaction of their decisions will be higher. We suggest that doctors can encourage patients and their families to participate in treatment decisions in the future.
致謝 ii
摘要 iii
Abstract iv
目錄 vi
表目錄 viii
圖目錄 ix
第一章緒論 1
第一節研究背景與動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 醫病共享決策 4
第二節 退化性膝關節炎 13
第三節 文獻小結 19
第三章 研究方法 20
第一節 研究流程 20
第二節 研究架構 20
第三節 研究對象與資料來源 21
第四節 樣本數 21
第五節 研究工具 21
第六節 研究變項操作型定義 23
第七節 分析方法 24
第八節 研究倫理考量 24
第四章 研究結果 25
第一節 信效度分析 25
第二節 退化性膝關節炎患者基本屬性之描述性統計 25
第三節 醫病互動角色偏好、共享決策程度及決策滿意度之描述性統計 28
第四節 基本屬性對醫病互動角色偏好、共享決策程度與決策滿意度之影響 32
第五節 醫病互動角色偏好對共享決策之影響 37
第六節 醫病互動角色偏好和共享決策程度對決策滿意度之相關性 38
第五章 討論 40
第一節 影響醫病互動角色偏好、共享決策程度和決策滿意度之因素 40
第二節 醫病互動角色偏好對共享決策程度之影響 42
第三節 醫病共享決策對決策滿意度之相關性 43
第六章 結論與建議 45
第一節 結論 45
第二節 建議 46
第三節 研究限制 46
參考文獻 48
英文文獻 48
中文文獻 54
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