Patient preference for involvement, experienced involvement, decisional conflict, and satisfaction with physician: a structural equation model test.
Patient preference for involvement, experienced involvement, decisional conflict, and satisfaction with physician: a structural equation model test.
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DOI：
10.1186/1472-6963-13-231
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发表时间：
2013-06-25
影响因子：
2.8
通讯作者：
Härter M
中科院分区：
文献类型：
--
作者：
Hölzel LP;Kriston L;Härter M
关于不同共同决策相关结构之间的关系及其对患者相关结果的影响的综合模型在很大程度上是缺失的。我们研究的目标是开发一个模型，将医疗会诊中的决策与中期和长期终点联系起来。对以下假设进行了检验：医生更倾向于让患者参与并愿意在医疗决策过程中承担责任，增加患者参与减少决策冲突，较低的决策冲突有利于影响患者对医生的满意度。该模型在德国初级保健样本(N = 1,913)中进行了测试。采用心理测量学工具评估以下内容：患者参与医疗决策的偏好、患者参与医疗决策的经历、决策冲突以及对初级保健提供者的满意度。结构方程模型被用来探索多重关联。该模型在开发子样本中进行了测试和调整，并在验证性样本中进行了交叉验证。人口统计学和临床特征被认为是可能的混杂因素。当地和全球指数表明，理论模型和数据之间的吻合程度可以接受。患者参与度的增加与决策冲突的减少密切相关(标准化回归系数Β = −.73)。高经验参与(Β = .34)和低决策冲突(B = -.28)都预示着对医生更高的满意度。患者的参与偏好与有经验的参与呈负相关(B = −.24)。总而言之，除了参与偏好和经验参与之间意外的负相关外，我们的模型在很大程度上可以被收集的经验数据所证实。未来对不同SDM相关结构之间的关联的研究应纳入纵向研究，以加强因果关联的假说。
A comprehensive model of the relationships among different shared decision-making related constructs and their effects on patient-relevant outcomes is largely missing. Objective of our study was the development of a model linking decision-making in medical encounters to an intermediate and a long-term endpoint. The following hypotheses were tested: physicians are more likely to involve patients who have a preference for participation and are willing to take responsibility in the medical decision-making process, increased patient involvement decreases decisional conflict, and lower decisional conflict favourably influences patient satisfaction with the physician. This model was tested in a German primary care sample (N = 1,913). Psychometrically tested instruments were administered to assess the following: patients’ preference for being involved in medical decision-making, patients’ experienced involvement in medical decision-making, decisional conflict, and satisfaction with the primary care provider. Structural equation modelling was used to explore multiple associations. The model was tested and adjusted in a development sub-sample and cross-validated in a confirmatory sample. Demographic and clinical characteristics were accounted for as possible confounders. Local and global indexes suggested an acceptable fit between the theoretical model and the data. Increased patient involvement was strongly associated with decreased decisional conflict (standardised regression coefficient Β = −.73). Both high experienced involvement (Β = .34) and low decisional conflict (B = -.28) predicted higher satisfaction with the physician. Patients’ preference for involvement was negatively associated with the experienced involvement (B = −.24). Altogether, our model could be largely corroborated by the collected empirical data except the unexpected negative association between preference for involvement and experienced involvement. Future research on the associations among different SDM-related constructs should incorporate longitudinal studies in order to strengthen the hypothesis of causal associations.
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DOI：
10.1080/10705519909540118
发表时间：
1999-01-01
影响因子：
6
作者：
Hu, Li-tze;Bentler, Peter M.
通讯作者：
Bentler, Peter M.
影响因子：
3.5
作者：
Kryworuchko, Jennifer;Stacey, Dawn;Graham, Ian D.
通讯作者：
Graham, Ian D.
影响因子：
--
作者：
Forrest, CB
通讯作者：
Forrest, CB
影响因子：
3.2
作者：
Elwyn, Glyn;Miron-Shatz, Talya
通讯作者：
Miron-Shatz, Talya
DOI：
10.1046/j.1369-6513.2003.00234.x
发表时间：
2003-09-01
期刊：
Health expectations : an international journal of public participation in health care and health policy
影响因子：
--
作者：
Legare, France;Tremblay, Stephane;Jacobsen, Mary Jane
通讯作者：
Jacobsen, Mary Jane