初產婦之醫病共享決策成效對於自我效能於醫病關係品質之中介影響研究

Mediating Effect of the Effectiveness of Primiparas' Doctor-Patient Shared Decision-Making Between Self-Efficacy and Quality of DoctorPatient Relationships

目的 本研究參考過去學者量表，以瞭解初產婦之 自我效能、醫病共享決策成效對於醫病關係品質 是否具有正向影響關係，並進一步探討初產婦之 醫病共享決策成效在自我效能與醫病關係品質間 之中介效果。 方法 本研究採用便利抽樣方式進行問卷調查，以中 部某區域級教學醫院產科門診，研究對象為產科 門診之初產婦，在產科醫師同意之下由訪員發放問 卷。資料收集期間為2020年1月至2020年4月，研究 問卷總共發放219份，有效回收率為71.69％，並採 用描述性統計分析、信度及效度分析、迴歸分析與 中介效果等方法進行分析。 結果 本研究樣本平均年齡為31歲，教育程度以專科 或大學居多，且初產婦大都已確認好想以自然產 的方式生產，參與醫病共享決策的家人中以配偶最 具影響力。本研究驗證，初產婦的自我效能對於醫 病共享決策成效及醫病關係品質有正向影響關係， 且在醫病共享決策成效在自我效能與醫病關係品質 間，的確扮演著部份中介之角色。 結論 醫病共享決策證實有效提升醫病關係品質。初 產婦參與醫病共享決策過程，建議其配偶應共同參 與，且醫院管理者應設法提升醫師與病人認同醫病 共享決策成效之優點，定期舉辦醫療專業人員在職 教育。醫院其他科別為了想提升醫病關係品質，推動醫病共享決策實為一不錯之策略或方案。（澄清醫護管理雜誌 2021；17（3）：8-19）。

Purposes This study referred to previously developed scales to examine whether primiparas' SelfEfficacy and the effectiveness of Doctor-Patient Shared Decision-Making have a positive influence on the Quality of Doctor-Patient Relationships. Further, it explores the mediating effect of the effectiveness of Doctor-Patient Shared Decision-Making between primiparas' Self-Efficacy and the Quality of Doctor-Patient Relationships. Methods We administered a questionnaire survey by means of convenient sampling. Primiparas who visited the obstetric outpatient clinic of a regional teaching hospital in central Taiwan were enrolled as the research subjects, and the questionnaire was distributed by interviewers with the obstetricians' approval. The data collection period lasted from January to April 2020. A total of 219 research questionnaires were distributed, and the recovery rate of valid questionnaires was 71.69%. Descriptive statistics, reliability and validity analysis, regression analysis, mediating effect, and other methods were applied to conduct the analysis. Results The average age of the study participants was 31 years, and their education level was mostly junior college or university. Most primiparas had confirmed that they wanted to give birth by spontaneous vaginal delivery. Their spouses were the most influential family members who participated in the Doctor-Patient Shared Decision-Making. This study verified that primiparas' Self-Efficacy had a positive impact on the effectiveness of Doctor-Patient Shared DecisionMaking and the Quality of Doctor-Patient Relationships. Moreover, it played a partial mediating role between Self-Efficacy and the Quality of Doctor-Patient Relationships. Conclusions It was verified that Doctor-Patient Shared Decision-Making can effectively improve the Quality of the Doctor-Patient Relationship. When primiparas participate in Doctor-Patient Shared DecisionMaking, it is suggested that their spouses should also participate. Furthermore, hospital administrators should try to improve doctors' and patients' recognition of the advantages of Doctor-Patient Shared Decision-Making, and hold regular on-the-job education for medical professionals. To improve the quality of Doctor-Patient Relationships in other departments of hospitals, a good strategy or scheme is to promote doctor-patient Shared Decision-Making. (Cheng Ching Medical Journal 2021; 17(3): 8-19)