Path analysis of the influence of shared decision-making between doctors and patients on psychological stress among patients with coronary heart disease / 中国实用护理杂志

ABSTRACT

Objective:To explore the influencing factors of psychological stress in patients with coronary heart disease, and the effect path of joint decision-making between doctors and patients on psychological stress and to provide reference for the formulation of management plan for physical and mental health of patients with coronary heart disease.Methods:From July 2017 to April 2022, 715 retired patients with coronary heart disease hospitalized in General Hospital of the People′s Liberation Army and Air Force Hospital in Western Military Theater of the People′s Liberation Army were investigated adopted cross-sectional survey method by simple random sampling using general information questionnaire, Stress Response Questionnaire, Shared Decision-making Questionnaire between Doctors and Patients, Uncertainty in Illness Scale and Simple Coping Style Questionnaire. By using structural equation modeling, the direct and indirect influence paths of shared decision-making between doctors and patients on psychological stress were analyzed.Results:The scores of psychological stress, shared decision-making, uncertainty in illness, positive coping style and negative coping style were 49.81 ± 11.06, 79.24 ± 8.68, 76.40 ± 12.56, 21.67 ± 5.51 and 8.90 ± 3.12. Correlation analysis showed that the scores of psychological stress were positively correlated with the scores of uncertainty in illness and negative coping style ( r=0.661, 0.591, both P<0.01), and negatively correlated with the scores of shared decision-making between doctors and patients and positive coping style ( r=-0.623, -0.451, both P<0.01). Path analysis showed that shared decision-making between doctors and patients had a direct effect on psychological stress, accounting for 23.81% of the total effect; the uncertainty in illness, positive coping style and negative coping style played a part of intermediary role between the joint decision-making between doctors and patients and psychological stress, accounting for 32.35%, 8.40% and 17.93% of the total effect respectively; the uncertainty in illness and negative coping style had a chain mediating effect between them, accounting for 17.51% of the total effect. Conclusions:It suggests that the shared decision-making between doctors and patients with coronary heart disease is not only directly related to psychological stress, but also indirectly related to psychological stress through uncertainty in illness and coping style, among which coping style may play a role of "pivot" to a certain extent.