Sak Gabriele, Rothenfluh Fabia, Schulz Peter J
Institute of Communication and Health (ICH), Università della Svizzera italiana (USI), Via G. Buffi 13, 6900, Lugano, Switzerland.
BMC Geriatr. 2017 Feb 20;17(1):59. doi: 10.1186/s12877-017-0448-x.
Research has confirmed a positive link between patient involvement in decision-making and improvements in health outcomes. The objective of this study was to examine the roles of psychological empowerment and health literacy on the elderly's willingness to engage in treatment decisions.
A self-administered questionnaire was completed by a randomly selected sample of Swiss adults aged 65-80 years old (N = 826). Multivariate logistic regression was applied to determine the contribution of health literacy, psychological empowerment, and trust in physician on participants' preference to be active, collaborative or passive in decision-making.
Most of the survey respondents preferred some participation in dealing with health related decisions (collaborative: 51%, and active: 35.6%). More than two-thirds of the sample was satisfied with their current involvement in medical decision-making (72.7%). Roughly one-fifth (18.8%) wished to attain a more active engagement than currently experienced, and the remainder of the sample preferred the opposite (8.5%). Due to higher reported levels of psychological empowerment and health literacy, Swiss-German seniors significantly preferred and assumed higher participation in medical decisions than Swiss-Italians. Psychological empowerment correlated with older adults' preferred and perceived involvement in medical decision-making. However, health literacy only predicted actual involvement in the last treatment decision that had to be made, differentiating only the active from the passive involvement group. Additionally, this research showed that health literacy mediated the relationship between psychological empowerment and the actual involvement in the last treatment decision that had to be made by the participant. Trust in physician and age appeared to be barriers to involvement, whereas education served as a facilitator.
As older adults' health literacy plays a role in individuals' willingness to attain an active role in health care decision-making, public health efforts should aim at developing programs and appropriate information that facilitate this process, especially for individuals with moderate or lower levels of health literacy. The current investigation showed that adequate health literacy levels are essential (but not sufficient) in order to reach higher rates of participation in the healthcare context. This research complements past evidence by adding knowledge on the psychosocial antecedents, and their combined effects on patients' involvement in healthcare.
研究已证实患者参与决策与健康结果改善之间存在积极联系。本研究的目的是探讨心理赋能和健康素养对老年人参与治疗决策意愿的作用。
由随机抽取的65 - 80岁瑞士成年人样本（N = 826）完成一份自填式问卷。应用多变量逻辑回归来确定健康素养、心理赋能以及对医生的信任对参与者在决策中选择积极、协作或被动角色的影响。
大多数调查受访者倾向于在一定程度上参与健康相关决策（协作：51%，积极：35.6%）。超过三分之二的样本对其目前参与医疗决策的程度感到满意（72.7%）。约五分之一（18.8%）的人希望比目前更积极地参与，其余样本则倾向于相反情况（8.5%）。由于报告的心理赋能和健康素养水平较高，说瑞士德语的老年人比说瑞士意大利语的老年人明显更倾向并实际更多地参与医疗决策。心理赋能与老年人倾向的以及感知到的参与医疗决策情况相关。然而，健康素养仅能预测在必须做出的最后一个治疗决策中的实际参与情况，仅能区分积极参与组和被动参与组。此外，本研究表明健康素养介导了心理赋能与参与者必须做出的最后一个治疗决策中的实际参与之间的关系。对医生的信任和年龄似乎是参与的障碍，而教育则起到促进作用。
由于老年人的健康素养在个体积极参与医疗保健决策的意愿中发挥作用，公共卫生工作应致力于制定促进这一过程的项目和提供适当信息，特别是针对健康素养水平中等或较低的个体。当前调查表明，足够的健康素养水平对于在医疗保健环境中实现更高的参与率至关重要（但不充分）。本研究通过补充关于社会心理前因及其对患者参与医疗保健的综合影响的知识，完善了以往的证据。
