Mao Ying, Ning Wei, Zhang Ning, Xie Tao, Liu Jinnan, Lu Yongbo, Zhu Bin
School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an 710049, China.
Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an 710049, China.
Int J Environ Res Public Health. 2021 Mar 26;18(7):3460. doi: 10.3390/ijerph18073460.
With a surge of conflicts between healthcare workers and patients in recent years, the therapeutic relationship (TR) in China is presently in tension. Meanwhile, consequent issues have begun to emerge, such as the distrust between healthcare workers and patients and the decline in the quality of medical services. Although many empirical studies about the TR have been conducted in China, previous studies on TR and its influencing factors have been contradictory. Therefore, this study conducted a systematic review and meta-analysis to assess the current situation of the TR and to identify factors associated with the TR in Chinese hospitals from three perspectives (healthcare worker, patient, and therapeutic interaction). Two reviewers independently searched the literature, selected researches, and extracted data through comprehensively searching of three international electronic databases and three Chinese electronic databases to identify all relevant observational studies on influencing factors for TR in China published in English and Chinese from January 2000 to January 2020. Among the 3290 records initially identified, 11 studies met the selection criteria. A total of 96,906 individuals were included in the review. The results showed that 55.73% of healthcare workers consider the TR to be tense, and 33.7% of patients hold this view. The meta-analysis indicated that healthcare workers who were male, older, less educated, working in a non-surgical department, and had a senior title were more likely to be pessimistic about the TR. Patients who were rural residents, highly educated, and had no medical insurance were more likely to be pessimistic about the TR. Furthermore, the mutual trust could improve rapport between healthcare workers and patients. The 25 other related factors related to the TR were analyzed and described using a narrative approach. The findings might deserve consideration in the design of relative policies to promote harmony between doctors and patients.
近年来，医护人员与患者之间的冲突激增，中国的治疗关系（TR）目前处于紧张状态。与此同时，随之而来的问题也开始出现，比如医护人员与患者之间的不信任以及医疗服务质量的下降。尽管中国已经开展了许多关于治疗关系的实证研究，但以往关于治疗关系及其影响因素的研究结果相互矛盾。因此，本研究进行了一项系统综述和荟萃分析，从医护人员、患者和治疗互动这三个角度评估中国医院治疗关系的现状，并确定与治疗关系相关的因素。两位评审员通过全面检索三个国际电子数据库和三个中国电子数据库，独立地搜索文献、选择研究并提取数据，以识别2000年1月至2020年1月期间以英文和中文发表的所有关于中国治疗关系影响因素的相关观察性研究。在最初识别的3290条记录中，有11项研究符合入选标准。该综述共纳入了96,906名个体。结果显示，55.73%的医护人员认为治疗关系紧张，33.7%的患者也持此观点。荟萃分析表明，男性、年龄较大、受教育程度较低、在非外科科室工作且具有高级职称的医护人员对治疗关系更可能持悲观态度。农村居民、受教育程度高且没有医疗保险的患者对治疗关系更可能持悲观态度。此外，相互信任可以改善医护人员与患者之间的融洽关系。使用叙述性方法对与治疗关系相关的其他25个因素进行了分析和描述。这些研究结果在制定促进医患和谐的相关政策时可能值得考虑。
