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題名:診間醫病關係之探究- 以多元文化為觀點
作者:陳偉權
作者(外文):CHEN, WEI-CHUAN
校院名稱:國立高雄師範大學
系所名稱:成人教育研究所
指導教授:王政彥
學位類別:博士
出版日期:2017
主題關鍵詞:多元文化醫病關係多元文化素養multiculturismdoctor-patient relationshipmulticultural literacy
原始連結:連回原系統網址new window
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為了更深一層了解醫病關係,本研究嘗試從門診醫病關係感知之醫療社會學意涵,以社會學之多元文化及素養之觀點來探究醫病關係,期待瞭解醫病關係失衡的可能原因,另覓改善醫病關係之思維方向。
本研究採用量性問卷調查與質性訪談研究方法增進研究效度。結構式問卷-「多元文化觀點之醫病關係感知」問卷,內容包含(1)受測者背景變項,(2)結果變項之主體性、權力/知識、責任倫理、關懷倫理四構面,與(3)調節變項之多元文化素養的多元文化覺知與知識二構面。問卷編製經過前測、因素分析、信度分析,調整各變項之構面後,作成正式問卷。共計831位有效樣本,包括病人691與醫師140位,地區涵蓋位於高雄地區之地區教學醫院、區域教學醫院及恆春鎮之地區醫院之門診病人及醫師。並以t檢定、單因子變異數分析、皮爾森積差相關分析、及多元迴歸分析等統計方法,進行資料分析與考驗研究假設。此外,以半結構式訪談大綱訪談9位門診病人與8位代表不同層級醫院之資深醫師,獲得之質性資料作為強化研究論述之依據。
經統計分析資料與資料整理編目後獲致下列結論:
壹、 整體而言,量性與質性研究結果一致,病人與醫師之多元文化觀點感知程度有差距,且病人顯著低於醫師。病人感知以「主體性」最高,「權力/知識」最低;醫師感知以「責任倫理」最高,「權力/知識」最低。病人與醫師均以「多元文化知識」感知較高。質性研究結果顯示,受訪病人全部認為尊重病人的差異對增進醫病關係的重要,但都只於「應然面」的期待。
貳、 影響多元文化觀點感知差異的因素:「主體性」方面,病人包括年齡、族群,醫師包括性別、族群、階級與宗教信仰。「權力/知識」方面,病人包括年齡、居住地、婚姻狀態與宗教信仰,醫師包括性別。「責任倫理」方面病人包括年齡、族群、宗教信仰與醫院層級,醫師包括年齡。「關懷倫理」方面,病人包括年齡、族群,醫師包括婚姻狀態、年資。
參、 影響多元文化素養感知差異的因素:「多元文化覺知」方面,病人不受影響,醫師為收入。「多元文化知識」方面,病人為教育水準,醫師為年齡、居住地、宗教信仰、年資與醫院層級。
肆、 病人與醫師之感知及素養各層面間的相關性均達顯著水準,且都屬於低度正相關。多元文化知識與權力/知識則均為負相關。
伍、 病人之多元文化覺知對於年齡與職業對主體性,以及對於所看診之醫院層級對權力/知識具有調節效果。然而,對責任倫理及關懷倫理不具有調節效果。
陸、 醫師之多元文化知識對於年齡對主體性與權力/知識具有調節效果。然而,對責任倫理及關懷倫理不具有調節效果。
為減少病人與醫師的「文化盲」,使醫師能放下權力的權威,鼓勵病人感知到充權的需要,達到醫師會「反思」與病人能「充權」的目的。本研究的具體建議為:
壹、 建議將多元文化與醫療社會學的議題與觀念,導入醫學院醫學倫理課程討論的主題。
貳、 將多元文化課程納入醫院內繼續教育課程,使多元文化教育成為醫療人員繼續教育課程的一個部份。
參、 結合公部門、學協會、民間團體與媒體資源,將多元文化觀點醫病關係「充權」的觀念,透過衛教活動傳遞給民眾。
In order to further understand the meaning of sociology of medicine in doctor-patient relationship at out-patient department, this research attempted to explore doctor-patient relationship in the perspective of multiculturalism. Both quantitative investigation and qualitative interview methods were used. The questionnaire” perception of doctor-patient relationship in perspective of multiculturism ” was designed through steps of pre-test, factor analysis and reliability analysis. 691patients and 140 doctors at out-patient department were enrolled in this study from different level of hospitals. The data were analyzed by t-test, one-way variance analysis, Pearson product correlation analysis, and multivariate regression analysis. 9 outpatients and 8 senior doctors representing different levels of hospitals were interviewed by a semi-structured interview outline to obtain qualitative data.
The research includes the following conclusions:
1. Overall, quantitative results were consistent with those of qualitative research. Perception level of multiculturism including subjectivity, power / knowledge, ethic of responsibility respectively, multicultural awareness and multicultural knowledge were significantly lower in patient group Qualitative results disclosed that respecting difference between doctors and patients is important in improving the quality of doctor-patient relationship but only expecting at level of " what ought to be " for patients.
2. Regarding the background factors affecting the multicultural perception were as follows: patient’s age and ethnicity, doctor’s gender, ethnicity, class and religious belief in subjectivity ; patient’s age, place of residence, marital status and religious belief and doctor’s gender in power / knowledge; patient’s age, ethnicity, religious beliefs and hospital levels and doctor’s age in responsibility ethic ; patient’s age and ethnicity and doctor’s marital status and seniority in care ethic.
3. Regarding the background factors affecting the multicultural awareness is only income for doctors, but none for patients. Those affecting multicultural knowledge is place of residence, religious beliefs, seniority and hospital level for doctor and education level for patients.
4. The correlation between patient’s and doctor’s multicultural perception and literacy was significant but low in degree, yet, multicultural knowledge and power / knowledge was negatively corrected.
5. Patient’s perception was affected by background variables and moderated by multicultural awareness. The reciprocation between age, occupation and multicultural awareness on subjectivity; location of hospital and multicultural awareness on power/knowledge was obvious.
6. Doctor’s perception is affected by background variables and moderated by multicultural knowledge. The reciprocation between age and multicultural knowledge on subjectivity and power/knowledge was obvious.
The researcher therefore addressed some suggestions as follows:
1. it is recommended that the topics and concepts of multiculturism and medical sociology might be introduced into the course of medical ethics in medical school.
2. The inclusion of multiculturism in the curriculum makes multicultural education a part of the continuing education curriculum for medical personnel.
3. The concept of empowerment from multicultural perspective in doctor-patient relationship, might be delivered to the public through the health education activities by combinating resources from public sector, academia, civil society and media.
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