Whose advocacy counts in shaping elderly patients' satisfaction with physicians' care and communication?
Whose advocacy counts in shaping elderly patients' satisfaction with physicians' care and communication?
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DOI：
10.2147/cia.s165086
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发表时间：
2018
影响因子：
3.6
通讯作者：
Langendoerfer KB
中科院分区：
文献类型：
--
作者：
Kahana B;Yu J;Kahana E;Langendoerfer KB
本文的目的是检验患者的自我倡导和感知的医生倡导在医生沟通和医患关系方面影响患者满意度的相对重要性。我们还考察了医生的情绪支持和患者的人口统计以及健康特征对患者满意度的影响。我们的样本包括对806名社区居住的老年人(平均年龄=77.82岁，SD=8.41)的访谈。样本包括美国佛罗里达州克利尔沃特市一个大型退休社区的居民。受访者也来自居住在美国佛罗里达州奥兰多和迈阿密以及美国俄亥俄州克利夫兰的老年人的代表性样本。运用多层次回归分析，我们发现患者的年龄和功能限制与他们的护理满意度负相关。与白人患者相比，非洲裔患者对医生的满意度较低，而拉丁裔患者对医疗服务的满意度较高。我们发现患者自我倡导的证据有限，而且这种倡导并不能作为医生满意度的重要预测指标。相比之下，患者对医生是否愿意充当患者代言人的看法是患者满意度的重要预测因素。医生的情感支持也与患者的满意度有关。这些发现提出了关于老年人中消费者赋权的问题，并强调了他们对医生倡导的渴望和赞赏。研究结果是在老年患者和他们的医生之间权力失衡的背景下讨论的。
The purpose of this article was to examine the relative importance of patients’ self-advocacy and perceived physicians’ advocacy for impacting patients’ satisfaction in terms of physician communication and physician–patient relationship. We also examine the influence of physicians’ emotional support and patients’ demographic as well as health characteristics on patients’ satisfaction. Our sample includes interviews with 806 community dwelling older adults (mean age =77.82 years, SD=8.41). The sample included residents of a large retirement community in Clearwater, FL, USA. Respondents were also included from representative samples of older adults living in Orlando and Miami, FL, USA, and Cleveland, OH, USA. Using multiple hierarchical regression analyses, we found that patients’ age and functional limitations were negatively associated with their care satisfaction. When compared with White patients, African-American patients were less satisfied with their physicians while Latino patients expressed greater satisfaction with their medical care. We found limited evidence of patients’ self-advocacy and such advocacy did not serve as a significant predictor of satisfaction with physicians. In contrast, patients’ perception of physicians’ readiness to act as patient advocates was a significant predictor of patients’ satisfaction. Emotional support of physicians was also associated with patients’ satisfaction. These findings raise questions about consumer empowerment among older adults and underscore their desire for and appreciation of physicians’ advocacy. Findings are discussed in the context of power imbalance between elderly patients and their doctors.