【作者】 王玥；

【导师】 马敬东；

【作者基本信息】 华中科技大学 ， 图书情报， 2021， 硕士

【摘要】 [目的]医患沟通一直以来都是备受关注的社会的热点问题,良好的医患沟通能够促进现代医学模式的发展、完善医疗过程、促进医学事业与社会文明进步和发展等。技术辅助医患沟通指的是在沟通过程中传播渠道选择使用信息技术从而辅助医生和患者之间完成信息交换的有别于传统面对面形式的医患沟通如语音通话、电子邮件、视频会话等。随着互联网医疗行业的快速的发展,技术辅助医患沟通在医患沟通中使用的频率逐渐增高,逐步成为人们经常使用的医患沟通方式,在互联网医疗的发展过程中扮演着重要角色。在理论上技术辅助医患沟通优点诸多如信息传递速度快、效率高、利于长期护理,但是实际互联网环境应用中医患双方对技术辅助沟通的反馈却并不理想如限制医疗工作者主观能动性、信息反馈不及时、安全性和准确性无法得到保障。因此本研究为了解技术辅助沟通的效果,比较技术辅助沟通与面对面沟通两者之间的差别,探究影响技术辅助沟通效果的重要影响因素,结合相关理论和模型基础对收集的样本数据进行分析,并根据具体分析结果提出相关建议,使得技术辅助医患沟通能更适应于互联网医疗环境,有效节约医疗资源。[方法]本研究通过对技术辅助沟通相关领域的文献进行归纳总结,对医疗互联网发展、技术辅助医患沟通现状、沟通效果的评价等进行文献综述,综合分析比较后选取以“以患者为中心”的沟通评价方法为基础,结合社会信息处理理论、网络去抑制效应等理论特点,对影响技术辅助医患沟通的因素提出假设,构建相关研究模型。通过问卷调查,收集有过技术辅助医患沟通经历的患者数据。根据已有的成熟量表进行改变后编制本研究的问卷,对问卷先进行预调查,选取医学院学生为样本,对问卷进行信效度检验,对不符合要求的测量题项进行删改,使用修改过的问卷进行实证分析。运用SPSS软件对数据进行信效度检验以及项目分析后,对各变量进行描述性统计分析,将面对面沟通背景下的数据与技术辅助沟通背景下的数据进行对比,得出二者之间在各维度之间的差异。然后运用AMOS软件,构建相关结构方程模型,通过使用极大似然估计方法来检验模型拟合度,再通过路径系数检验各变量之间的相关关系,验证之前提出的研究假设。[结果]根据各维度的得分情况得知,技术辅助医患沟通效果在沟通质量(11.66±2.597)和沟通满意度(11.51±2.023)两个维度得分均较高,评价较好;技术辅助沟通(A组)和面对面沟通(B组)在医生态度(A:15.37±3.772;B:15.77±3.628)、医患关系平等(A:19.65±4.748;B:19.61±4.733)、患者焦虑程度(A:10.68±3.294;B:11.47±3.136)、患者自我披露程度(A:15.85±3.640;B:15.48±3.838)、沟通满意度(A:11.51±2.023;B:11.21±2.059)、沟通质量(A:11.66±2.597;B:11.69±2.243)这六个维度得分均有差异,与面对面医患沟通相比技术辅助医患沟通过程中医患关系平等、患者焦虑程度、患者自我披露程度和沟通满意度都较好,但是医生态度和沟通质量方面技术辅助医患沟通得分较差于面对面医患沟通。研究共提出的九条假设,除了患者焦虑程度相关假设以及医患关系平等对沟通满意度的假设未成立,其余假设均成立。在技术辅助医患沟通中,医生态度对沟通质量(p=***)和沟通满意度(p=0.002)均有显著影响;自我披露程度对沟通质量(p=0.005)和沟通满意度(p=0.048)均有显著影响;医患关系平等对沟通质量有显著影响(p=0.007),但是对沟通满意度情况无显著影响(p=0.088);患者焦虑程度对沟通质量(p=0.963)和沟通满意度(p=0.816)均无显著影响。值得注意的是,沟通质量对沟通满意度具有显著影响(p=***),各维度与沟通满意度之间除了直接影响外,还通过对沟通质量产生影响从而对沟通满意度产生间接影响。[结论]医生态度、医患关系平等、患者自我披露程度是技术辅助医患沟通效果的重要影响因素;其中医生态度、患者自我披露程度均以沟通质量为中介变量对沟通满意度产生影响。整体来说技术辅助医患沟通的效果评价较好。更多还原

【Abstract】 [Purpose]Doctor-patient communication has always been a foucs in society.Good doctor-patient communication can promote the development of modern medical models,improve the medical process,and promote the progress and development of medical career and social civilization.Technology-assisted doctor-patient communication refers to use information technology to assist doctors and patients to complete information exchange,such as voice calls,emails,and video conversations,which is different from traditional face-to-face communication between doctors and patients.This study mainly conducts a questionnaire survey on technology-assisted doctor-patient communication users,conducts a statistical analysis on the sample data,and understands the effect of technology-assisted doctor-patient communication,compares the difference between technology-assisted doctor-patient communication and face-to-face communication,and further explores the important influencing factors of the effect of technology-assisted doctor-patient communication.Suggestions are put forward according to the specific analysis results,so that the doctor-patient communication can be more adapted to the Internet medical environment and effectively save medical resources.[Methods]Based on the "patient-centered" communication evaluation method,combined with social information processing theory,network disinhibition effect and other characteristics,this study proposed hypotheses on the factors affecting technology-assisted doctor-patient communication,and constructed relevant research models.Through questionnaire survey,the data of patients who had experience in technology-assisted doctor-patient communication were collected.Pre-survey was conducted first and then empirical analysis was conducted.After SPSS software was used to test the reliability and validity of the data,descriptive statistical analysis was conducted on all variables,and the differences between face-to-face communication and technology-assisted communication were compared to be obtained.Then,AMOS software was used to build the relevant structural equation model.After the model fitting degree was tested,the correlation between the variables was tested through the path coefficient to verify the hypothesis.[Results]The effect of technology-assisted doctor-patient communication is evaluated highly.Compared with face-to-face doctor-patient communication,technology-assisted doctor-patient communication has better doctor-patient relationship equality,patient anxiety,patient self-disclosure and communication satisfaction.However,in terms of doctors’ attitude and communication quality,technology-assisted doctor-patient communication is worse than face-to-face doctor-patient communication.At the same time,among the nine hypotheses proposed in this study,all the other hypotheses are valid except the hypothesis related to the degree of patient anxiety and the hypothesis that the doctor-patient relationship equality is related to communication satisfaction.[Conclusions]The attitude of doctors,the equality of doctor-patient relationship and the degree of self-disclosure of patients are the important factors affecting the effectiveness of technology-assisted doctor-patient communication.Doctors’ attitude and patients’ degree of self-disclosure both have an impact on communication satisfaction with communication quality as a mediating variable.On the whole,the effect of technology-assisted doctor-patient communication is evaluated well.更多还原