医患信任关系的结构和测量及其整合模型

从概念结构和测量工具角度对相关文献进行系统梳理和剖析发现：既有研究主要集中于患方视角而相对忽视了医方信任测量；测量维度上存在各种不同指标，主要涉及医患双方在就医过程中的态度、能力和行为，以及二者对医患关系亲密程度感知的心理结构。总结不同视角的相关研究，本研究提出了医患信任关系的总体概念框架和医患信任测量的整合模型，旨在构建医患信任测量的总体框架及测量指标，以期为后续研究和实践工作提供参考和指导。

Structure and Measurement of Doctor-patient Trust and its Integrated Model

Trust of Doctor-patient relationship has always been an important research area of medical ethics and social psychology. This study reviewed the literature related to the measurement of doctor-patient trust in recent years and systematically analyzed them from the aspects of conceptual structure and measurement scales. It is found that there are a variety of measurement dimensions, mainly involving the attitude, ability and behavior of doctors and patients in the process of medical treatment, as well as the psychological structure of perceived intimacy of doctor-patient relationship. The purpose of this study is to construct the overall framework and measuring indicators of trust measurement of patients and doctors. The current researches mainly focused on structural measurement of doctor-patient trust from the perspective of the patient. Most of them take the weak position of patients as analysis foundation and stress patients' emotional factors in the process of doctor-patient trust. At present, the development of measurement tools of patient trust has been diversified. Scholars generally adopt multi-dimension and multi-level scale forms. According to psychological structure and content of patient trust, its measurement can be divided into the following three types: differently targeted patient trust measurement, psychological structure-based patient trust measurement and doctor features-based patient trust measurement. Through combing the basic features of some important patient trust scales, statistics find out that “Technical Competence”, “Confidentiality”, “Honesty”, and “Benevolence” appeared several times in different scales, which indicates that patient trust is largely determined by professional ability and competence of medical service. And “Loyalty” and “Global Trust” becomes the measurement dimension used once and again by scholars, which indicate that patient trust also originates from self-perception of doctors and their medical service.Doctor trust in patients is also an important component of doctor-patient trust. Broadly speaking, doctor trust involves doctor trust in patients, medical institutions and medical systems. However, existing researches only cover doctor trust in patient, with most of them measuring from doctors’ subjective perception of doctor-patient relationship as well as patients’ behavior and attitude in seeking treatment. This is because doctors were in an advantaged position due to possession of medical knowledge and ability of treating diseases under traditional bio-medical environment. Hence doctors hold a central position in the building process of doctor-patient trust relationship. Therefore, scholars diluted the interaction of doctor-patient trust relationship and relatively neglect the measurement of trust in medical side at the primary stage of doctor-patient trust research.To summarize and integrate current studies systematically, this research attempts to propose a general conceptual framework of doctor-patient trust relationship to show multiple dimensions of doctor-patient relationship in a broad sense. This conceptual framework not only pays attention to general trust relationship and interpersonal trust relationship between doctors and patients aiming to cure diseases and restore health for patients, but also stresses organizational trust of medical system.To clarify different perspectives and measurement dimensions of doctor-patient trust measurement, this research integrates the relevant researches and proposes an integration model of measurement tools of doctor-patient trust ultimately. With a view to promoting the scientization and standardization of the measurement of doctor-patient trust relationship, this mode summarizes different objects, psychological structure, character features of both parties, and positive and negative direction measurement of doctor-patient trust.