Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, Hunan, China.
Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
Soc Psychiatry Psychiatr Epidemiol. 2022 Oct;57(10):2119-2129. doi: 10.1007/s00127-022-02296-w. Epub 2022 May 2.
Due to the family-oriented cultural and legal context in China, understanding the difference between patients' and family members' experiences of psychiatric services not only enriches perspectives of service quality assessment, but also promotes service utilization. This study aimed to compare experiences of psychiatric inpatient services between patients and their family members in China.
The study included 126 dyads of patients and family members consecutively recruited from the psychiatric inpatient department in a large hospital in China. The responsiveness performance questionnaire was used to measure the experiences of psychiatric inpatient services after patient discharge. After adjusting reporting heterogeneity based on vignettes, dyad difference was examined by intraclass correlation coefficients (ICCs) and paired Wilcoxon signed-rank tests with Bonferroni correction in multigroup testing. Subgroup analyses were conducted within strata of four selected clinical and socio-demographic factors, to test their influence on difference pattern of experiences.
Poor consistency was found for all responsiveness items and the total scores among the 126 dyads and in most subgroup analyses (ICC < 0.6). Paired Wilcoxon signed-rank tests found that patients rated lower than their family members on the item of "asking user's opinions" in 126-dyad comparison (P < 0.05) and 3 subgroups related to severe mental disorders and income inequality after Bonferroni correction.
Results reveal inconsistent experiences of psychiatric inpatient services within families in China. Moreover, when making medical decisions, family members' opinions, rather than patients', are more frequently taken into consideration, especially on conditions where imbalanced decision-making power exists between patients and their family members. In the future, user experience improvement should pay equal attention to patients and family members, and the benefits of family involvement and patients' rights of shared decision-making should be carefully balanced.
由于中国文化和法律以家庭为导向，了解患者和家庭成员对精神科服务体验的差异不仅丰富了服务质量评估的视角，还有助于服务的利用。本研究旨在比较中国精神科住院患者和其家庭成员的精神科住院服务体验。
该研究纳入了 126 对来自中国一家大型医院精神科住院病房的患者和家庭成员。使用反应性表现问卷在患者出院后评估其对精神科住院服务的体验。在根据情景调整报告异质性后，通过组内相关系数（ICC）和配对 Wilcoxon 符号秩检验以及多组检验中的 Bonferroni 校正来检验患者和家庭成员之间的体验差异。在四个选定的临床和社会人口学因素的亚组内进行了亚组分析，以检验这些因素对体验差异模式的影响。
在 126 对患者和家庭成员以及大多数亚组分析中，所有反应性项目和总分的一致性都很差（ICC < 0.6）。配对 Wilcoxon 符号秩检验发现，在 126 对比较中，患者对“征求用户意见”这一项目的评分低于其家庭成员（P < 0.05），在与严重精神障碍和收入不平等相关的 3 个亚组中，经 Bonferroni 校正后差异仍有统计学意义。
结果表明，中国家庭内部对精神科住院服务的体验不一致。此外，在做出医疗决策时，家庭成员的意见而不是患者的意见更常被考虑，尤其是在患者及其家庭成员之间存在不平衡的决策权时。未来，改善用户体验应该平等关注患者和家庭成员，并且应该仔细平衡家庭参与和患者共同决策的利益。
