牙科病患對醫療告知的認知研究:以大台中地區為例

A Study on Dental Patients’ Understanding of Medical Disclosure: in Taichung Area

張溫鷹(Wen-Ying Chang)

指導教授 ： 李勝揚

臺北醫學大學/口腔醫學院/牙醫學系碩博士班/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00222

摘要

背景: 近日牙科的醫療糾紛增加快速，發生原因以「認知溝通不足」占絕大部分。病患多數認為，牙醫師的說明不夠清楚及對診療過程不瞭解。
目的: 探討牙科病患對於牙醫醫療告知的認知程度及其相關因子，為目前牙醫醫病雙方型態的改變提供可依循的方式，進而提昇醫病關係，降低醫療糾紛。
方法:本研究採橫斷式調查及結構式問卷收集資料，時間為2010年4月至5月，研究對象為大台中地區各區牙醫診所之病患。由同一位問卷調查員至隨機抽樣之牙科診所取得同意後，對現場結束治療並同意之病患進行資料收集，共取樣62家牙醫診所，取得300份有效問卷。
結果: 牙醫醫療告知認知項目最高分四個項目依序為「病情」說明瞭解、「治療內容」說明瞭解、「回家使用藥物」說明瞭解、「自費藥物」說明瞭解，介於清楚與非常清楚間。最低分四個項目依序為「治療成功率」說明瞭解、「治療時使用的藥物」說明瞭解、「治療併發症與後遺症」說明瞭解、「麻醉相關」說明瞭解，介於可接受與清楚間。複迴歸分析顯示，與醫師熟識程度高、治療結果滿意度高、溝通方式滿意度高、溝通內容滿意度高，則醫療告知認知分數越高；職業為公教者、職業為學生者，醫療告知認知分數越低；這六個因子可解釋57%的變異量。
結論: 與醫師熟識程度為牙醫醫療告知認知之重要影響因素，顯示醫病信任關係的建立可提升牙科病患對牙醫醫療告知認知程度。而滿意度與牙醫醫療告知認知達顯著相關，證實告知後同意有助於增進牙科病患對牙醫醫療品質的感受，驗證告知後同意程度評估之外在效度，進而深化未來牙醫醫學教育之內涵。

關鍵字

醫療告知 ； 告知後同意 ； 醫病溝通 ； 醫病關係

並列摘要

Background: The recent rapid increase of medical disputes in dental department mainly results from the deficiency of cognitive communication. Most of the patients believe that the explanation for the treatment from dentists is not clear enough.

Objective: The aim is to probe into the cognition degree of medical information disclosure from dentists of dental patients and related factors, to provide ways to follow for the change of relationship between dentists and patients, and finally to enhance the relationship between dentists and patients, lowering medical disputes.

Methods: A cross-sectional research and structured questionnaire was applied to collect information in this study between April and May in 2010. The objects were the dental patients around Taichung area. The information-collection was carried out after gaining the consents of the dental clinics and the patients after they received treatment by a questionnaire investigator. 62 dental clinics were sampled and 300 valid questionnaires obtained.

Results: The highest-level classification of medical information disclosure includes four items: explanation of “patient’s condition”, “content of treatment”, “home use of drugs”, and “drugs at patient’s own expense” with understanding levels between clear and very clear. The lowest-level classification of medical information disclosure includes four items: explanation of “treatment success rates”, “drugs used in treatment”, “complications and sequelae after treatment”, and “Anesthesia related information” with understanding levels between acceptable and clear. Multiple regression analysis showed that the score of medical information disclosure is high if the patient’s familiarity to dentists is high, the satisfaction of treatment high, the satisfaction of communication ways high, and the satisfaction of communication content high. The medical information disclosure score is low if the professions of patients are civil service and student. The six factors explained 57% of the variance.

Conclusions: The level of familiarity to dentists is an essential factor of medical information disclosure, and the build of trust between dentists and patients can elevate the patient’s cognitive level of medical information disclosure. The satisfaction level and medical information disclosure shows a significant correlation, proving that the consent after medical information disclosure helps improve the patient’s feeling of dental health care quality. The result also verifies the magnitude of validity of the assessment of consent after information disclosure, and further deepens the content of dental medicine education in the future.

並列關鍵字

Medical Information Disclosure ； Inform consent ； Physician-Patient Communication ； Physician-Patient Relationship

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