Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, USA.
J Crit Care. 2012 Feb;27(1):3-10. doi: 10.1016/j.jcrc.2011.04.006. Epub 2011 Jun 28.
To examine the performance and properties of the Revised Health Care System Distrust Scale among surrogates in the intensive care unit (ICU).
Pilot, prospective cohort study of 50 surrogates of adult, mechanically ventilated patients surveyed on days 1, 3, and 7 of ICU admission.
Responses on the Health Care System Distrust Scale on day 1 ranged from 9 to 34 (possible range 9-45, with higher scores indicating more distrust), with a mean and SD of 20.3 ± 6.9. Factor analysis demonstrated a 2-factor structure, corresponding to the domains of values and competence. Cronbach α for the overall scale was .83, for the competence subscale, .76, and for the values subscale, .74. Health-care system distrust was inversely correlated with trust in ICU physicians (Pearson coefficient -.63). When evaluated over the course of each patient's ICU stay, health-care system distrust ratings decreased by 0.31 per patient-day (95% CI 0.55-0.06, P = .015). Correlation between health-care system distrust and trust in ICU physicians decreased slightly over time.
Among surrogates in the ICU, the Health Care System Distrust Scale has high internal consistency and convergent validity. There was substantial variability in surrogates' trust in the health-care system.
考察修订后的医疗保健系统不信任量表在重症监护病房（ICU）中的代理者中的表现和特性。
对 50 名成年、机械通气患者的代理人进行了试点前瞻性队列研究，在 ICU 入院的第 1、3 和 7 天进行了调查。
第 1 天健康保健系统不信任量表的评分范围为 9 至 34（可能范围为 9-45，得分越高表示不信任程度越高），平均得分为 20.3 ± 6.9。因子分析显示存在 2 个因子结构，分别对应于价值观和能力领域。总体量表的克朗巴赫 α 为.83，能力子量表为.76，价值观子量表为.74。医疗保健系统不信任与 ICU 医生的信任呈负相关（Pearson 系数 -.63）。当在每位患者 ICU 住院期间进行评估时，医疗保健系统不信任评分每患者日下降 0.31（95%CI 0.55-0.06，P =.015）。医疗保健系统不信任与 ICU 医生信任之间的相关性随着时间的推移略有下降。
在 ICU 中的代理人中，医疗保健系统不信任量表具有较高的内部一致性和收敛效度。代理人对医疗保健系统的信任存在很大差异。
