Research On The Application And Influencing Factors Of Shared Decision Making In Outpatient Treatment Of Cardiovascular Diseases

BackgroundA civilized,harmonious and healthy doctor-patient relationship plays a vital role and an indispensable responsibility in the development of the national medical and health service system and the formation of a good social atmosphere.With the rapid development of the information age,patients have changed from the traditional passive acceptance of medical and health services to autonomous and spontaneous requests to participate in clinical medical joint decision-making(shared).decision making,SDM)mode.At present,as a major disease with high morbidity and mortality in our country,cardiovascular and cerebrovascular diseases not only cause tremendous physical and psychological damage to the people,but also cause great harm to the country and society.How can it be effective?Prevention and control of cardiovascular and cerebrovascular diseases,and how to better cure cardiovascular and cerebrovascular diseases have become urgent issues that the country and all walks of life need to solve.With the diversification and complexity of diagnostic methods and treatments for cardiovascular and cerebrovascular diseases,patients with cardiovascular and cerebrovascular diseases and doctors need scientific and effective doctor-patient communication and joint decision-making when facing choices.Therefore,this study aims to test the reliability and validity of the doctor-patient joint decision-making scale in the field of cardiovascular and cerebrovascular diseases,explore the influencing factors of doctor-patient joint decision-making,and provide effective clinical data for improving medical quality and improving the medical service system.ObjectivesThis study aims to verify the psychometric characteristics of the doctor-patient joint decision-making scale in outpatients and doctors of cardiovascular and cerebrovascular diseases,and to provide measurement tool support to promote the development of doctor-patient joint decision-making;from the perspective of doctors and patients,analyze the impact of doctor-patient joint Decision-making factors,explore the relationship between the demographic characteristics of patients and doctors and SDM,and improve the quality of medical services and patient satisfaction.MethodsThe selected subjects of this study are outpatients in Qingdao Municipal Hospital,and the survey time is from August 2020 to October 2020.A total of 647 patients and doctors were investigated.The questionnaire includes general patient information,SDM-Q-9、WHO-5、PHQ-9、GAD-7、SDM-Q-Doc and MSQ.Analysis methods and indicators mainly include:1.Descriptive analysis:statistical indicators such as mean,median,quartile;2.Reliability and validity:internal consistency analysis,Cronbach coefficient,exploratory factor analysis;3.Single factor analysis:Kruskal-Wallis H non-parametric test,Spearman related non-parametric test;4.Multiple linear regression analysis.Results1.The basic situation of the sample population In this studyA total of 514 outpatients were surveyed,of which 6 patients refused to participate in the survey,and a total of 508 valid questionnaires were included in the outpatient survey.Among them,there are 318 female cases,accounting for 61.90%;the average age of the total sample is 45± 16.72 years;a total of 81 valid questionnaires were included in the doctor survey,including 40 males,accounting for 49.38%;the average age of the total sample was 33.48±1.061 years.2.The reliability and validity analysisThe Cronbach’s a coefficient of the SDM-Q-9 scale for outpatient cardio-cerebrovascular patients was 0.971 and the Spear-Brown split-half reliability coefficient(unequal length)was 0.970.The KMO(Kaiser-Meyer-Olkin)coefficient of the test statistic is 0.947,and the chi-square value of Bartlett’s test is 5905.254(df=36,P<0.001);the Cronbach’s a coefficient of the doctor’s SDM-Q-doc scale is 0.912 and the Spear-Brown split-half reliability coefficient(unequal length)is 0.893.The KMO(Kaiser-Meyer-Olkin)coefficient of the test statistic is 0.887,and the chi-square value of Bartlett’s test is 608.093(df=36,P<0.001).This shows that the patient version of the joint decision questionnaire(SDM-Q-9)and the doctor version of the joint decision questionnaire(SDM-Q-Doc)have good reliability and structural validity.In addition,the World Health Organization’s five physical and mental health indicators(WHO-5),Patient Health Questionnaire Depression Scale(PHQ-9),Generalized Anxiety Scale(GAD-7)and Minnesota Job Satisfaction Scale(MSQ)All showed good reliability and validity.Influencing factors of SDMIn the multiple linear regression model,the SDM-Q-9 score results are related to education level,self-perceived illness severity,medical service satisfaction,communication methods,doctor-patient relationship attitudes,and average questions.There is a linear correlation between the diagnosis time(P<0.05).Education level,self-perceived severity of illness,communication methods,attitudes of doctor-patient relationship,average consultation time,and satisfaction with medical services have higher β standard values(β standard>0.1).Except for working years,there is no linear correlation between the doctor’s other demographic characteristics and the scores of the SDM-Q-doc.ConclusionsThe SDM-Q-9 and the SDM-Q-doc show good reliability and validity in Chinese outpatients and clinicians of cardiovascular and cerebrovascular diseases,and are a reliable and feasible test for the results of joint doctor-patient decision-making.Measuring tools.The education level,the attitude of the doctor-patient relationship,the average consultation time,the satisfaction of medical services,and the self-perceived severity of the illness are important factors that influence the doctor-patient joint decision-making of the outpatients with cardiovascular and cerebrovascular diseases.