Abstract:

Objective To explore the mediating effects of perceived stress and uncertainty tolerance on health literacy and decision satisfaction of decision makers in patient undergoing cardiac macrovascular surgery，and to provide references for improving the satisfaction of decision-making. Methods 260 surgical patient’s decision-makers in the cardiac macrovascular surgery of a hospital in Wuhan were selected by convenience sampling. All Aspects of Health Literacy Scale，Perceived Stress Scale，Intolerance of Uncertainty Scale-12 and decision satisfaction scale were used to investigate. Results 251 valid questionnaires were recovered，with an effective recovery rate of 96.54%. The health literacy score was（23.05±5.61）；the perceived stress score was（20.31±6.08）；the uncertainty tolerance score was（26.41±5.94）；the decision satisfaction score was（43.86±10.54）. The 4 variables were correlated（P<0.001）. The mediating model found that health literacy had a significant direct effect on decision satisfaction. Meanwhile，health literacy also indirectly affected decision satisfaction through 3 paths，including the independent mediating effect of perceived stress（β=0.096，P<0.001），the independent mediating effect of uncertainty tolerance （β=0.093，P=0.001），the chain mediating effect of perceived stress and uncertainty tolerance（β=0.076，P<0.001），accounting for 49.17% of the total effect. Conclusion Perceived stress and uncertainty tolerance play a mediating role in the relationship between health literacy and decision satisfaction of decision makers in cardiac macro-vascular surgery，which can improve decision makers’ health literacy，reduce perceived stress，and help them perceive surgical risks rationally，thus improving decision satisfaction.

Key words: Thoracic Surgery, Decision-Making, Health Literacy, Perceived Pressure, Uncertainty Tolerance, Root Cause Analysis, Nursing Care

摘要：

目的 探究感知压力和不确定性忍受度在心脏大血管手术患方决策者健康素养与决策满意度间的中介效应，为提高心脏大血管手术决策满意度提供思路。 方法 2021年10月—2022年5月，采用便利抽样法，抽取武汉市某三级甲等综合医院心脏大血管外科260名手术患方决策者作为调查对象，使用全面健康素养测量量表、感知压力量表、简版无法忍受不确定性量表、决策满意度量表进行调查。 结果 最终回收有效问卷251份，有效问卷回收率为96.54%。心脏大血管手术患方决策者健康素养得分为（23.05±5.61）分，感知压力得分为（20.31±6.08）分，不确定性忍受度得分为（26.41±5.94）分，决策满意度得分为（43.86±10.54）分，4个变量均具有相关性（P<0.001）。中介模型显示，健康素养对决策满意的直接效应显著，同时，健康素养还通过3条路径间接影响决策满意，包括感知压力的独立中介作用（β=0.096，P<0.001）、不确定性忍受度的独立中介作用（β=0.093，P=0.001）、感知压力与不确定性忍受度的链式中介作用（β=0.076，P<0.001），中介效应占总效应的49.17%。 结论 感知压力与不确定性忍受度在心脏大血管手术患方决策者健康素养与决策满意间发挥中介作用，可通过提高决策者健康素养，减轻压力知觉，使其理智看待手术风险，提高决策满意度。

关键词: 胸外科学, 医疗决策, 健康素养, 感知压力, 不确定性忍受度, 影响因素分析, 护理