中文版防御性医疗量表（DMS）：医生群体中的信度和效度检验。

The Chinese version of Defensive Medicine Scale (DMS): reliability and validity test among physicians.

机构信息

Department of Psychology, School of Teacher Education, Shaoxing University, Shaoxing, 312000, People's Republic of China.

School of Education, Jilin International Studies University, Changchun, 130117, People's Republic of China.

出版信息

BMC Psychol. 2024 Aug 31;12(1):462. doi: 10.1186/s40359-024-01957-6.

DOI:10.1186/s40359-024-01957-6

PMID:39217402

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11365130/

Abstract

BACKGROUND

Physicians are inclined to resort to defensive medicine (DM) for self-protection due to the increasing potential risk of medical litigation. DM is globally prevalent and has become an impediment to the development of healthcare. However, there is a lack of validated tools specifically designed to assess DM in China. Therefore, this study aimed to evaluate the psychometric properties of the Chinese version of Defensive Medicine Scale (DMS) among clinicians to provide a practicable tool for relevant research.

METHODS

The present research consists of two phases. In Phase 1, DMS was administered to survey 327 physicians, and the collected data were obtained for item analysis and exploratory factor analysis. Phase 2 applied DMS to survey 323 physicians, from which the data was used for confirmatory factor analysis, and reliability and cross-cohort consistency tests. Moreover, the participants of Phase 2 were required to complete Workplace Well-Being Scale (WWBS), Career Commitment Scale (CCS), Occupational Disidentification Scale (ODS), Intent to Leave Scale (ILS), and Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) to test the convergent validity of DMS.

RESULTS

The Chinese version of DMS consists of 10 items divided into 2 dimensions, Positive Defensive Medicine (PDM) and Negative Defensive Medicine (NDM). The confirmatory factor analysis showed that the two-factor model fitted well (χ/df = 2.540, RMSEA = 0.069, CFI = 0.981, IFI = 0.981, TLI = 0.971, PNFI = 0.646, PCFI = 0.654, SRMR = 0.044). Furthermore, the total score and the score of each dimension for DMS had a significant negative correlation with WWBS and CCS scores, and a significant positive correlation with ODS, ILS, and DDPRQ-10 scores. The Cronbach's α coefficients for the total DMS and PDM and NDM dimensions were 0.917, 0.935, and 0.842, respectively; the split-half reliability coefficients were 0.922, 0.947, and 0.839, respectively. In addition, DMS showed cross-gender invariance.

CONCLUSION

The Chinese version of DMS has been demonstrated to be an effective tool to assess defensive medicine among Chinese physicians with good psychometric properties.

摘要

背景

由于医疗诉讼的潜在风险日益增加，医生倾向于采取防御性医疗（DM）来自我保护。DM 在全球范围内普遍存在，已成为医疗保健发展的障碍。然而，中国缺乏专门用于评估 DM 的经过验证的工具。因此，本研究旨在评估中文版防御性医疗量表（DMS）在中国临床医生中的心理测量特性，为相关研究提供实用工具。

方法

本研究分为两个阶段。在第 1 阶段，对 327 名医生进行 DMS 调查，收集的数据用于项目分析和探索性因素分析。第 2 阶段应用 DMS 对 323 名医生进行调查，利用数据进行验证性因素分析、可靠性和跨队列一致性检验。此外，第 2 阶段的参与者需要完成工作场所幸福感量表（WWBS）、职业承诺量表（CCS）、职业认同量表（ODS）、离职意向量表（ILS）和医患关系困难问卷（DDPRQ-10），以测试 DMS 的收敛效度。

结果

中文版 DMS 由 10 个项目组成，分为积极防御性医疗（PDM）和消极防御性医疗（NDM）两个维度。验证性因素分析表明，两因素模型拟合良好（χ/df=2.540，RMSEA=0.069，CFI=0.981，IFI=0.981，TLI=0.971，PNFI=0.646，PCFI=0.654，SRMR=0.044）。此外，DMS 的总分和各维度得分与 WWBS 和 CCS 得分呈显著负相关，与 ODS、ILS 和 DDPRQ-10 得分呈显著正相关。DMS 的总得分和 PDM 和 NDM 维度的克朗巴赫 α 系数分别为 0.917、0.935 和 0.842，分半信度系数分别为 0.922、0.947 和 0.839。此外，DMS 表现出跨性别不变性。