急性缺血性脑卒中溶栓代理决策者的决策困境及影响因素

doi:10.3761/j.issn.0254-1769.2023.01.003

摘要/Abstract

摘要：

目的调查急性缺血性脑卒中患者溶栓代理决策者的决策困境现状及影响因素。方法选取2019年9月—2021年12月在河南省郑州市某综合性三级甲等医院急诊科就诊的急性缺血性脑卒中患者及其代理决策者为调查对象，收集患者及代理决策者的社会人口学资料及患者疾病相关资料，并由代理决策者填写决策困境量表、决策参与期待量表、维克森林医师信任量表、感知社会支持量表和状态焦虑问卷，使用SPSSAU对数据进行统计分析，使用Pearson相关分析及Spearman相关分析探索各变量与决策困境的相关性，使用岭回归分析探索决策困境的影响因素。结果共纳入383例急性脑卒中溶栓患者的代理决策者，决策者决策困境得分为（35.37±14.57）分，56.4%的代理决策者得分≥25分，存在决策困境；代理决策者决策困境的影响因素包括社会人口学因素（患者年龄、决策者性别及文化程度、医疗保险类型、患者经济负担、付费者与患者关系）、情绪及心理因素（决策者焦虑水平、对医师的信任水平、社会支持水平）、患者疾病相关因素（患者国立卫生研究院卒中评分量表评分、发病时段、复发次数）、决策过程的特征（参与决策的人数、患者是否参与决策）。结论大多数急性缺血性脑卒中患者的代理决策者存在决策困境，医护人员在进行溶栓知情同意沟通时应关注代理决策者的心理特征，并采用适当的沟通技巧或提供必要的决策辅助。

关键词: 急性缺血性脑卒中, 溶栓, 决策困境, 调查研究, 影响因素分析, 护理

Abstract:

Objective To investigate the status and influencing factors of thrombolysis decisional conflict of proxies decision-makers in patients with acute ischemic stroke. Methods The patients with acute ischemic stroke and their decision-makers were selected from September 2019 to December 2021 in the emergency department of a tertiary A hospital in Zhengzhou，Henan Province. The sociodemographic data and disease-related data of the patients and decision-makers were collected. The decision-makers filled in the Decisional Conflict Scale，the Decision-making Participation Expectation Scale，the Wake Forest Physician Trust Scale，the Perceived Social Support Scale and the State Anxiety Scale，and SPSSAU was used to analyze the data. Pearson and Spearman correlation analysis were used to explore the correlation between variables and decisional conflict，and ridge regression analysis was used to explore the influencing factors. Results A total of 383 decision-making proxies of patients were included in this study. The score of decisional conflict was 35.37±14.57，and 56.4% decision-making proxies had decisional conflict with scores >25. The influence factors of the decisional conflict included sociodemographic factors（patient age，decision-maker gender and education level，medical insurance type，patient economic burden，payer-patient relationship），emotional and psychological factors（decision-maker anxiety level，trust to physician，social support），patients’ disease-related factors（NIHSS，onset period，recurrence times），and characteristics of the decision-making process （number of people involved in the decision-making，whether patients participate in decision-making）. Conclusion Most of the decision-making proxies have decision-making difficulties. The sociodemographic characteristics，psychological characteristics of patients and decision makers and their trust in physicians will affect the decisional conflict. Medical staff should pay attention to the psychological characteristics of decision makers in the process of obtaining thrombolytic informed consent，adopt appropriate communication skills and provide necessary decision-making assistance.

Key words: Acute Ischemic Stroke, Thrombolysis, Decisional Conflict, Survey Research, Root Cause Analysis, Nursing Care

郭园丽, 杨彩侠, 郭丽娜, 董小方, 高欢欢, 吕培华, 马珂珂. 急性缺血性脑卒中溶栓代理决策者的决策困境及影响因素[J]. 中华护理杂志, 2023, 58(1): 23-30.

GUO Yuanli, YANG Caixia, GUO Lina, DONG Xiaofang, GAO Huanhuan, LÜ Peihua, MA Keke. The decisional conflict and influence factors of proxies of patients with acute ischemic stroke in thrombolysis decision-making[J]. Chinese Journal of Nursing, 2023, 58(1): 23-30.

图/表 4

表1 代理决策者的一般资料及其与决策困境的相关性（n=383）

Table 1 The general information of decision makers and the correlation with decisional conflict（n=383）

表2 患者的一般资料及其与代理决策者决策困境得分的相关性（n=383）

Table 2 The general information of patients and the correlation with decisional conflict（n=383）

表3 分类变量赋值表

Table 3 Assignment for categorical variable

表4 急性缺血性脑卒中溶栓代理决策者决策困境影响因素的岭回归分析结果（n=383）

Table 4 The ridge regression results of the decisional conflict influence factors of proxies of patients with acute ischemic stroke in thrombolysis decision-making（n=383）

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