Fan Jing, Li Shiyuan, Qiang Yan, Duan Zhen, Wu Albert, Wang Ruiping
Clinical Research Center, Shanghai Skin Diseases Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
Bloomberg School of Public Health, University of Johns Hopkins, Baltimore, MD, USA.
Clin Cosmet Investig Dermatol. 2024 May 20;17:1153-1164. doi: 10.2147/CCID.S457802. eCollection 2024.
Shared decision making (SDM) is a collaborative process involving both healthcare providers and patients in making medical decisions, which gains increasing prominence in healthcare practice. But evidence on the level of SDM in medical practice and barriers as well as stimulus during the SDM implementation among aesthetic dermatologists is limited in China.
From July to August 2023, 1938 dermatologists were recruited online in China. Data were collected through an electronic questionnaire covering: (1) demographic features; (2) SDM questionnaire physician version (SDM-Q-Doc); and (3) stimulus and barriers in SDM implementation. Logistic regression was applied to explore factors associated with SDM practice, barriers, and stimulus of SDM implementation, respectively.
The 1938 dermatologists included 1329 females (68.6%), with an average age of 35 years. The total SDM score ranged from 0 to 45, with a median value of 40 (IQR: 35-44), and the median stimulus score and barriers scores were 28 (IQR: 24-32) and 19 (IQR: 13-26), respectively. The prevalence of good SDM was 27.2%, logistic regression indicated that female dermatologists (odds ratio, OR=1.21, 95% confidence interval, CI: 0.96-1.51), and dermatologists with more years of aesthetic practice had a higher proportion of good SDM practice (OR was 1.44 for 5-9 years, 1.58 for 10-15 years and 1.77 for over 15 years). Moreover, female dermatologists and dermatologists with higher education level and serviced in private settings had lower barrier scores; female dermatologists and dermatologists with more years of aesthetic practice had higher stimulus scores.
Chinese aesthetic dermatologists appear to implement SDM at an active level, with more stimulus and less barriers in SDM implementation. The integration of SDM into clinical practice among dermatologists is beneficial both for patients and dermatologists. Moreover, SDM practice should be strongly promoted and enhanced during medical aesthetics, especially among male dermatologists, dermatologists with less working experience, and those who work at public institutions.
共同决策（SDM）是一个医疗服务提供者和患者共同参与医疗决策的协作过程，在医疗实践中日益受到重视。但在中国，关于美容皮肤科医生医疗实践中的共同决策水平、实施过程中的障碍以及促进因素的证据有限。
2023年7月至8月，在中国在线招募了1938名皮肤科医生。通过电子问卷收集数据，内容包括：（1）人口统计学特征；（2）共同决策问卷医生版（SDM-Q-Doc）；（3）共同决策实施过程中的促进因素和障碍。分别应用逻辑回归分析探索与共同决策实践、共同决策实施的障碍及促进因素相关的因素。
1938名皮肤科医生中，女性1329名（68.6%），平均年龄35岁。共同决策总分范围为0至45分，中位数为40分（四分位间距：35 - 44），促进因素得分中位数和障碍得分中位数分别为28分（四分位间距：24 - 32）和19分（四分位间距：13 - 26）。良好共同决策的患病率为27.2%，逻辑回归分析表明，女性皮肤科医生（比值比，OR = 1.21，95%置信区间，CI：0.96 - 1.51）以及美容实践年限更长的皮肤科医生具有良好共同决策实践的比例更高（5 - 9年的OR为1.44，10 - 15年的OR为1.58，超过15年的OR为1.77）。此外，女性皮肤科医生、受教育程度较高且在私立机构工作的皮肤科医生障碍得分较低；女性皮肤科医生以及美容实践年限更长的皮肤科医生促进因素得分较高。
中国美容皮肤科医生似乎在积极实施共同决策，在共同决策实施过程中促进因素较多而障碍较少。将共同决策融入皮肤科医生的临床实践对患者和皮肤科医生都有益。此外，在医学美容过程中应大力推广和加强共同决策实践，尤其是在男性皮肤科医生、工作经验较少的皮肤科医生以及在公共机构工作的皮肤科医生中。
