Beach Mary Catherine, Sugarman Jeremy, Johnson Rachel L, Arbelaez Jose J, Duggan Patrick S, Cooper Lisa A
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
Ann Fam Med. 2005 Jul-Aug;3(4):331-8. doi: 10.1370/afm.328.
Although involving patients in their own health care is known to be associated with improved outcomes, this study was conducted to determine whether respecting persons more broadly, such as treating them with dignity, has additional positive effects.
Using data from the Commonwealth Fund 2001 Health Care Quality Survey of 6,722 adults living in the United States, we performed survey-weighted logistic regression analysis to evaluate independent associations between 2 measures of respect (involvement in decisions and treatment with dignity) and patient outcomes (satisfaction, adherence, and receipt of optimal preventive care). Then we calculated adjusted probabilities of these outcomes and performed stratified analyses to examine results across racial/ethnic groups.
After adjustment for respondents' demographic characteristics, the probability of reporting a high level of satisfaction was higher for those treated with dignity vs not treated with dignity (0.70 vs 0.38, P < .001) and for those involved in, versus not involved in, decisions (0.70 vs 0.39, P < .001). These associations were consistent across all racial/ethnic groups. Being involved in decisions was significantly associated with adherence for whites, whereas being treated with dignity was significantly associated with adherence for racial/ethnic minorities. The probability of receiving optimal preventive care was marginally greater for those treated with dignity (0.68 vs 0.63, P = .054), but did not differ with respect to involvement in decisions (0.67 vs 0.67, P = .95).
Being treated with dignity and being involved in decisions are independently associated with positive outcomes. Although involving patients in decisions is an important part of respecting patient autonomy, it is also important to respect patients more broadly by treating them with dignity.
尽管让患者参与自身医疗护理已知与改善治疗结果相关，但本研究旨在确定更广泛地尊重患者，如给予其尊严对待，是否具有额外的积极影响。
利用英联邦基金2001年对居住在美国的6722名成年人进行的医疗保健质量调查数据，我们进行了调查加权逻辑回归分析，以评估两种尊重措施（参与决策和尊严对待）与患者治疗结果（满意度、依从性和接受最佳预防保健）之间的独立关联。然后我们计算了这些结果的调整概率，并进行分层分析以检验不同种族/族裔群体的结果。
在对受访者的人口统计学特征进行调整后，接受尊严对待的患者报告高度满意度的概率高于未接受尊严对待的患者（0.70对0.38，P <.001），参与决策的患者高于未参与决策的患者（0.70对0.39，P <.001）。这些关联在所有种族/族裔群体中都是一致的。参与决策与白人的依从性显著相关，而接受尊严对待与种族/族裔少数群体的依从性显著相关。接受尊严对待的患者接受最佳预防保健的概率略高（0.68对0.63，P =.054），但在参与决策方面没有差异（0.67对0.67，P =.95）。
接受尊严对待和参与决策与积极的治疗结果独立相关。虽然让患者参与决策是尊重患者自主权的重要部分，但通过给予患者尊严更广泛地尊重患者也很重要。
