病人為中心思維之診間醫病關係－－以多元文化為觀點

Doctor-Patient Relationship of Patient-centeredness from Perspective of Multiculturalism

本研究旨在現今醫療主流之病人為中心的健康照護環境下，以多元文化觀點探究病人診間醫病關係的感知程度，並瞭解多元文化素養對醫病關係的影響。研究設計以病人之病背景為自變因素，依變因素包括病人對主體性、「權力／知識」、責任倫理與關懷倫理感知程度四個構面，中介因素為多元文化素養，包含覺知與知識二構面。結果發現感知以主體性最高，權力／知識最低。感知與素養各層面間的相關性均呈現顯著性的低度正相關，知識與權力／知識則為負相關。此外，多元文化素養能調節感知程度的差異，但只有覺知對於主體性以及「權力／知識」具有調節效果。因此，本研究建議將多元文化融入健康識能教育以提昇病人之多元文化素養的覺知能力，藉以達到以病人為中心，改善醫病關係之目的。

The study is aimed to explore patient's perception of doctor-patient relationship from multicultural perspective at out-patient department in healthcare system of patient-centeredness, nowadays and to investigate the influence of multicultural literacy on doctor-patient relationship. The study was designed by using independent variables of patient's background, dependent variables consisting four constructs of subjectivity, power/knowledge, responsibility ethics, and caring ethics and mediating variables of multicultural literacy including awareness and knowledge. The results showed that perception was the highest in subjectivity and the lowest in power/knowledge. The perception and literacy are significantly correlated positively at low-level, while knowledge and power/knowledge are negatively correlated. Multicultural literacy could regulate perceived differences. Only ＂awareness＂ has a regulatory effect on subjectivity and power/knowledge. This study suggests that the integration of multiculturalism into health literacy can enhance the patient's multicultural literacy of awareness to improve the patient's subjectivity and power/knowledge in doctor-patient relationship.