医患共同决策模式与中老年尿毒症患者 血液透析疗效相关性

Correlation between the Shared Decision-Making Model and Hemodialysis Efficacy in Middle-Aged and Elderly Patients with Uremia

摘要: 目的：本研究通过横断面研究设计，探讨医患共同决策模式与中老年尿毒症患者血液透析治疗效果的关系。方法：纳入2024年1月至2024年6月期间，在兴化市裕丰血透中心接受治疗的183例尿毒症患者，并收集医患双方的有效量表数据。采用中文版医患共同决策量表评估医患共同决策程度，根据SDM-Q-AVG分数进行K-Means聚类分析，分为高(n = 58)、中(n = 58)和低(n = 67)三类共同决策组。收集患者临床、实验室和透析等关键指标。数据分析采用SPSS27.0，对医患共同决策量表进行信效度检验，通过卡方检验，方差分析，回归分析影响血液透析疗效的因素，并在不同医患共同决策模式下分析决策得分与血液透析疗效的相关性。结果：医患低共同决策组的年龄更大，肌酐更高、尿酸更高，尿素更高，脱水量达标率更低(均p < 0.05)。多因素Logistic回归分析提示，医患共同决策的程度与中老年尿毒症患者血液透析疗效有关(p < 0.05, p < 0.001)。多元回归和相关性分析提示，医患共同决策程度与透析疗效有正相关性，且在医患共同决策程度较低的群体中相关性更为显著。结论：医患共同决策模式在预测中老年尿毒症患者血液透析治疗效果中具有重要作用。在血液透析前应用医患共同决策模式并及早进行干预，可能有助于提高血液透析的疗效。

Abstract: Objective: This study explored the relationship between the doctor-patient shared decision-making (SDM) model and the outcome of haemodialysis treatment in middle-aged and elderly uremic patients through a cross-sectional research design. Methods: One hundred and eighty-three patients with uremia who received treatment at Xinghua Yufeng Haemodialysis Centre between January 2024 and June 2024 were included, and validated scale data were collected from both doctors and patients. The Chinese version of the Doctor-Patient Shared Decision Making Scale was used to assess the degree of doctor-patient shared decision making, and K-Means cluster analysis was performed based on the SDM-Q-AVG scores, which were divided into three types of shared decision-making groups: high (n = 58), medium (n = 58) and low (n = 67). Key clinical, laboratory and dialysis indicators of patients were collected. Data were analysed using SPSS27.0, and the doctor-patient shared decision-making scale was tested for reliability and validity, and the factors affecting the efficacy of haemodialysis were analysed by chi-square test, analysis of variance (ANOVA), regression, and the correlation between the decision-making scores and the efficacy of haemodialysis was analysed under different doctor-patient shared decision-making modes. Results: The doctor-patient low shared decision-making group was older, had higher creatinine, higher uric acid, higher urea, and lower dehydration compliance (all p < 0.05). Multifactorial logistic regression analysis suggested that the degree of doctor-patient shared decision-making was associated with haemodialysis outcomes in middle-aged and elderly uremic patients (p < 0.05, p < 0.001). Multiple regression and correlation analyses suggested that the degree of doctor-patient shared decision-making was positively correlated with dialysis outcomes, and the correlation was more significant in the group with a lower degree of doctor-patient shared decision-making. Conclusion: The doctor-patient shared decision-making model plays an important role in predicting the outcome of haemodialysis treatment in middle-aged and elderly uremic patients. Applying the patient-physician shared decision-making model before haemodialysis and intervening early may help to improve the efficacy of haemodialysis.