Mediating effect of empathy on association between stress and doctor-patient relationship among doctors
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摘要:
目的 探讨医生共情能力在压力与医患关系间的中介效应。 方法 采用自编情况调查表、压力知觉量表和杰弗逊共情量表对黑龙江省哈尔滨市4所三级甲等医院的800名医生进行问卷调查,回收有效问卷757份。采用SPSS 24.0和Mplus 6.0对数据进行分析,包括描述性统计分析、t检验、χ2检验、Pearson相关性分析和logistic回归分析等。 结果 本研究中,583名(77.0 %)医生医患关系良好,174名(23.0 %)医生医患关系紧张。男女医生医患关系状况差异有统计学意义(χ2 = 14.644,P < 0.05);男女医生压力得分分别为(26.76 ± 4.51)和(26.21 ± 4.53)分,差异无统计学意义(t = 1.669,P > 0.05);男女医生共情能力得分分别为(104.85 ± 16.57)和(111.79 ± 11.43)分,差异有统计学意义(t = − 6.411,P < 0.05)。中介效应检验结果显示,男性医生共情能力在压力与医患关系间发挥部分中介作用,中介效应占总效应之比为13.10 %,女性医生共情能力在压力与医患关系间发挥完全中介作用。 结论 医生压力水平是导致医患关系紧张的重要因素。医生共情能力在压力与医患关系间发挥了中介效应,但是不同性别的医生共情能力在压力与医患关系间发挥的中介效应不同。男性医生压力不仅可以直接负向影响医患关系,还可以通过降低其共情能力来间接影响医患关系;而女性医生压力则完全通过降低其共情能力来影响医患关系状况。 Abstract:Objective To explore mediating effect of empathy on the association between stress and doctor-patient relationship among doctors. Methods We conducted a survey among 800 doctors selected from four grade-A tertiary hospitals in Harbin city during March – July, 2019. A self-compiled questionnaire, Perceived Stress Scale (PSS) and Jefferson Scale of Empathy (JSE) were adopted in the study. Descriptive statistics, t-test, chi-square test, Pearson correlation analysis, and logistic regression analysis were performed in data analyses with SPSS 24.0 and Mplus 6.0. Results Among 757 (94.63% of all the doctors surveyed) respondents with valid information, 583 (77.0%) and 174 (23.0%) reported a good and strained doctor-patient relationship and there was a significant gender-difference in the proportions of reporting a good or strained doctor-patient relationship (χ2 = 14.644, P < 0.05). The PSS scores were 26.76 ± 4.51 and 26.21 ± 4.53 for male and female doctors, without significant gender difference (t = 1.669, P > 0.05). The JSE scores were 104.85 ± 16.57 and 111.79 ± 11.43 for male and female doctors, with a significant gender difference (t = − 6.411, P < 0.05). Mediation effect analysis revealed that empathy played a full mediation role in the association between stress and doctor-patient relationship among female doctors but a partial mediation role, accounting for 13.10% of total effect, among male doctors. Conclusion For doctors, stress is an important factor leading to strained doctor-patient relationship and empathy mediates the association of stress with doctor-patient relationship, and the degree of the mediating effect differs by gender, with a full mediation in female doctors but a partial mediation in male doctors. -
Key words:
- doctor /
- doctor-patient relationship /
- empathy /
- stress /
- mediation effect
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表 1 不同特征医生医患关系比较
变量 紧张 良好 χ2 值 P 值 人数 百分比(%) 人数 百分比(%) 科室 9.490 0.091 内科 70 9.25 189 24.97 外科 51 6.74 143 18.89 妇儿科 12 1.59 68 8.98 五官科 14 1.85 64 8.45 医技科 16 2.11 77 10.17 其他 11 1.45 42 5.55 是否值夜班 22.647 0.000 是 157 20.74 425 56.14 否 17 2.25 158 20.87 工作环境 60.785 0.000 好 23 3.04 215 28.40 中 112 14.80 332 43.86 差 39 5.14 36 4.76 -
[1] 张广有. 中国医院协会: 医院暴力伤医事件年均27次[J]. 中华医学信息导报, 2013, 28(16): 6. [2] Qiao T, Fan Y, Geater AF, et al. Factors associated with the doctor-patient relationship: doctor and patient perspectives in hospital outpatient clinics of Inner Mongolia Autonomous Region, China[J]. Patient Preference and Adherence, 2019, 13: 1125 – 1143. doi: 10.2147/PPA.S189345 [3] 郑世通, 郑世茹, 任晓美. 医务人员视域下医患关系评价及其影响因素研究[J]. 中国医疗管理科学, 2019, 9(2): 67 – 72. doi: 10.3969/j.issn.2095-7432.2019.02.013 [4] 杨艳杰, 褚海云. 基于PAC人际交互作用理论的医患关系优化模式构建[J]. 中国社会心理学评论, 2018(1): 16 – 24. [5] 黄晓玲, 戴良铁. 医生群体因素在医患关系中影响及评价[J]. 中国公共卫生, 2016, 32(9): 1246 – 1248. doi: 10.11847/zgggws2016-32-09-29 [6] 张颖, 王淑霞, 孙焕文, 等. 新疆省某三甲医院临床医生职业工作压力及其与抑郁症状和高血压的相关性研究[J]. 国际精神病学杂志, 2018, 45(1): 81 – 83. [7] 王安琪, 赵厚宇, 张召锋, 等. 北京市某医院临床医生心理压力现状研究[J]. 中国社会医学杂志, 2016, 33(4): 370 – 373. doi: 10.3969/j.issn.1673-5625.2016.04.021 [8] Astrow AB. Jewish Values, Empathy, and the doctor-patient relationship[J]. Society, 2015, 52(5): 418 – 423. doi: 10.1007/s12115-015-9924-0 [9] 陈武英, 卢家楣, 刘连启, 等. 共情的性别差异[J]. 心理科学进展, 2014, 22(9): 1423 – 1434. [10] 胡敦蓉, 魏万宏. 临床护士工作压力与共情能力分析[J]. 当代医学, 2012, 18(20): 13 – 15. doi: 10.3969/j.issn.1009-4393.2012.20.007 [11] 刘婉婷, 蚁金瑶, 钟明天, 等. 压力知觉量表在不同性别大学生中的测量等值性[J]. 中国临床心理学杂志, 2015, 23(5): 944 – 946. [12] 安秀琴, 杨辉, 徐建萍, 等. 杰弗逊共情量表的编译及评价[J]. 护理研究, 2008, 22(8): 2063 – 2064, 2066. [13] 王楠. 浙江省医务人员遭受医疗暴力调查研究[D]. 杭州: 浙江大学, 2018. [14] O'Brien, Konrath SH, Grühn D, et al. Empathic concern and perspective taking: linear and quadratic effects of age across the adult life span[J]. The Journals of Gerontology: Series B, 2013, 68(2): 168 – 175. doi: 10.1093/geronb/gbs055 [15] Qiao ZX, Chen L, Chen MQ, et al. Prevalence and factors associated with occupational burnout among HIV/AIDS healthcare workers in China: a cross-sectional study[J]. BMC Public Health, 2016, 16(1): 335. doi: 10.1186/s12889-016-2890-7 [16] 尹绍雅, 赵静波, 赵久波, 等. 领悟社会支持在临床医生工作压力与共情疲劳间的中介作用[J]. 中华行为医学与脑科学杂志, 2016, 25(5): 452 – 455. doi: 10.3760/cma.j.issn.1674-6554.2016.05.014 [17] Christov-Moore L, Simpson EA, Coudé G, et al. Empathy: gender effects in brain and behavior[J]. Neuroscience and Biobehavioral Reviews, 2014, 46: 604 – 627. doi: 10.1016/j.neubiorev.2014.09.001 [18] Baez S, Flichtentrei D, Prats M, et al. Men, women…who cares? A population-based study on sex differences and gender roles in empathy and moral cognition[J]. PLoS One, 2017, 12(6): e0179336. doi: 10.1371/journal.pone.0179336 [19] 刘姗姗, 吴俊, 李明, 等. 基层全科医生的工作胜任度及满意度研究[J]. 中国全科医学, 2019, 22(10): 1218 – 1222. [20] Jones LM, Huggins TJ. Empathy in the dentist-patient relationship: review and application[J]. New Zealand Dental Journal, 2014, 110(3): 98 – 104.