心血管疾病患者对医生信任程度对其临床决策倾向性的影响.docVIP

心血管疾病患者对医生信任程度对其临床决策倾向性的影响 　　[摘要] 目的 了解心血管疾病患者对医生信任程度对其临床决策倾向性的影响，为促进医患和谐提供相应建议。 方法 应用问卷对北京市就诊的258例心血管疾病患者进行调查，了解其临床决策状况及其影响因素。 结果 89例（34.5%）患者倾向于“医生根据医学知识作出决策”，61例（（23.5%）患者倾向于“医生在询问患者需求后作出决策”，94例（36.4%）患者倾向于“和医生共同作出决策”，14例（5.4%）患者倾向于“和医生讨论后自己作出决策”；患者对医生的平均信任得分为（9.74±0.54）分。 结论 心血管疾病患者对医生的信任程度较高，患者对医生的信任程度受家庭人口数目、诊疗医生级别、该医生是否第1次为调查对象诊疗、医生在诊疗过程中耐心倾听患者讲话程度影响。 　　[关键词] 心血管疾病；临床决策；倾向性 　　[中图分类号] R05 [文献标识码] B [文章编号] 1673-7210（2014）09（a）-0135-04 　　[Abstract] Objective To investigate the impact of trust degree to the doctor on clinical decision-making tendency for patients with cardiovascular disease， in order to provide corresponding suggestions for promoting the harmony between doctors and patients. Methods 258 patients with cardiovascular disease in Beijing were investigated by questionnaire， the clinical decision-making status and its influencing factors were understanded. Results 89 （34.5%） patients were tend to the doctor to make decision according to medical knowledge， 61 （23.5%） patients were tend to the doctor to make decision in asking the patients needs， 94 （36.4%） patients were tend to make decisions with doctors， 14（5.4%） patients were tend to make decisions after discussion with doctor； the average score of patient trust in doctors was （9.74±0.54） points. Conclusion The trust degree to doctors is higher in patients with cardiovascular disease， the degree of trust to doctor is effected by the number of family members， doctors level， whether the doctor is the first as the research object， and the doctor listen to patients patiently in treatment process. 　　[Key words] Cardiovascular disease； Clinical decision； Tendency 　　随着我国社会经济的发展，人群心血管病的发病率和病死率逐年上升，发病年龄不断提前，已成为我国最重要的公共卫生问题之一。作为疾病诊治的核心环节，临床决策的地位举足轻重。临床决策（clinical decision making，CDM）是指临床专业知识与患者情况和最佳研究证据的结合，以求最大限度地提高临床决策的质量，使患者获得更好的临床疗效和生存转归。临床决策必须以“患者为中心”。随着医学模式的转变，患者的人文素质逐步得到提高，对与自身有关治疗的选择，患者有参与和了解的愿望。更重要的是，患者和医生都希望找到适合患者自身状况的个体化治疗方案，而这一目标，在没有患者参与的情况下显然难以实现[1]。研究表明，患者积极参与到临床决策中还可以节省医疗费用[2]。本研究通过对北京市