反驳文本对患方信任和道德判断的影响与机制 *

doi:10.3724/SP.J.1041.2019.01171

摘要/Abstract

摘要：

采用反驳文本范式对患方进行知识修正, 提升患方对医方的信任和道德判断。预实验编制反驳文本并验证其有效性, 实验1验证反驳文本可以显著提高患方的对医信任和道德判断, 并发现医疗结果是影响患方信任和对医道德判断的重要因素。实验2和实验3探究了反驳文本有效性的作用机制及适用普遍性, 发现不确定性容忍度和宽容度在反驳文本和患方信任及道德判断之间呈链式中介作用, 且反驳文本可脱离医学情境提升普遍患方信任。

关键词: 反驳文本, 医患关系, 患方信任, 道德判断, 不确定性容忍度

Abstract:

Mistrust between doctors and patients is a worldwide concern, especially in China. Among all possible driving factors, the knowledge gap between the two groups plays a key role in the formation of disparate cognitive styles between professional medical workers and laymen. If patients can be educated effectively and prompted to think like experts, they can become more compliant during medical treatment and more tolerant of unexpected diagnosis or treatment results, thus maintaining their trust in doctors. One possible effective way to make patients think like doctors is to conduct knowledge revision in health and medicine, a method that is counterintuitive to ordinary people but familiar to doctors. This process can be facilitated by the adoption of refutation texts, which state previously acquired but incorrect knowledge and then directly refute the wrong information while providing the correct knowledge.

In the present set of experiments, we systematically examined the effect and underlying mechanism of refutation texts under medical situations. Refutation texts were constructed in the pilot study. The texts consisted of five items that were familiar to doctors but peculiar and interesting to laymen. After asking 103 college students to guess “True” or “False” on each question, correct answers were provided for the participants. Subsequently, they were asked to assess if these answers prompted them to reflect that their previous beliefs were incorrect. At least 97 participants (94.2%) made one error in the test, and 81 participants (78.6%) admitted that this process prompted a reflection on their previous beliefs, a result that proved the effectiveness of refutation texts.

Study 1 was designed to test the effect of refutation texts constructed in the pilot study on patient’s trust and moral judgment on doctors using a 2 (intervention: with or without refutation texts) × 2 (compliance: following doctors’ instruction or not) × 2 (check result: common fever or leukemia) between-subject design. Participants were randomly assigned those eight conditions. First, participants were required to read a scenario of doctor-patient dialogue discussing whether bone marrow puncture (BMP) should be applied to a child. Then, they were required to guess the compliance of the child’s father before they were given the different combinations of the father’s decision and medical results. Participants were required to judge the intention of the doctor’s suggestion of BMP and assess how much trust they have in doctors. Results confirmed the significant effect of refutation texts on the participants’ trust and moral judgment. Participants who were provided refutation texts had higher trust scores and were more likely to judge the doctor’s intention positively and unselfishly compared with those who were not provided such texts. The medical inspection results influenced the participants’ judgment style and trust level. When the inspection showed a minor symptom, participants tended to show lower trust in the doctor and had negative attitude toward the doctor’s suggestion.

Study 2 tested the chain mediating role of intolerance of uncertainty and tolerance on medical workers. The same procedure as in Study 1 was used, except that participants’ scores were collected using the Intolerance of Uncertainty Scale and Tolerance on Medical Worker’s Questionnaire. Data were analyzed by using Process Plugin. Results showed a chain mediation effect on moral judgment but failed to confirm the same effect on trust. Moreover, Study 3 confirmed the effectiveness of refutation texts under non-medical-related situations and the chain mediating role of intolerance of uncertainty and tolerance on medical workers’ trust.

Our findings demonstrated the effectiveness of refutation texts in prompting laymen’s knowledge revision and reflection on their existing health beliefs. This result will improve the tolerance on unexpected treatment consequences and the doctors’ possible misdiagnosis, thus sustaining trust in the doctor. On the basis of our results, we recommend that odd but interesting knowledge of the human body and counter-intuitive medical facts can be employed as routine material in patient education to foster a reflexive attitude on possible unsatisfactory diagnosis or treatment results. Future research may construct more useful refutation text items and further explore the possible hindering effect of previous health beliefs and negative emotions of medical refutation texts.

Key words: refutation texts, doctor-patient relationship, patient’s trust;, moral judgment, tolerance of uncertainty

中图分类号:

吕小康, 付春野, 汪新建. (2019). 反驳文本对患方信任和道德判断的影响与机制 ^*. 心理学报, 51(10), 1171-1186.

LYU Xiaokang, FU Chunye, WANG Xinjian. (2019). Effect and underlying mechanism of refutation texts on the trust and moral judgment of patients. Acta Psychologica Sinica, 51(10), 1171-1186.

图/表 10

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类别	条件	n	%
错答情况	全部正确	6	5.8
	错1题	16	15.5
	错2题	20	19.4
	错3题	25	24.3
	错4题	30	28.6
	全部错误	6	5.8
干预有效性自评	非常不同意	2	1.9
	不同意	4	3.9
	一般	16	15.5
	同意	48	46.6
	非常同意	33	32.0

类别	条件	n	%
错答情况	全部正确	6	5.8
	错1题	16	15.5
	错2题	20	19.4
	错3题	25	24.3
	错4题	30	28.6
	全部错误	6	5.8
干预有效性自评	非常不同意	2	1.9
	不同意	4	3.9
	一般	16	15.5
	同意	48	46.6
	非常同意	33	32.0

反驳文本	遵医嘱行为	检查结果	n	道德判断(后测)	患方信任
反驳文本	遵医嘱行为	检查结果	n	M ± SD	M ± SD
实验组	做检查	普通发烧	40	7.63 ± 1.72	44.85 ± 8.01
	做检查	淋巴细胞白血病	41	8.39 ± 1.26	49.10 ± 5.83
	不做检查	普通发烧	36	6.92 ± 1.61	43.17 ± 9.48
	不做检查	淋巴细胞白血病	38	8.82 ± 1.14	47.18 ± 8.06
控制组	做检查	普通发烧	42	5.95 ± 2.32	35.40 ± 10.97
	做检查	淋巴细胞白血病	38	7.13 ± 1.61	41.05 ± 9.41
	不做检查	普通发烧	38	5.21 ± 2.04	34.39 ± 8.31
	不做检查	淋巴细胞白血病	36	7.78 ± 1.40	45.64 ± 8.22

反驳文本	遵医嘱行为	检查结果	n	道德判断(后测)	患方信任
反驳文本	遵医嘱行为	检查结果	n	M ± SD	M ± SD
实验组	做检查	普通发烧	40	7.63 ± 1.72	44.85 ± 8.01
	做检查	淋巴细胞白血病	41	8.39 ± 1.26	49.10 ± 5.83
	不做检查	普通发烧	36	6.92 ± 1.61	43.17 ± 9.48
	不做检查	淋巴细胞白血病	38	8.82 ± 1.14	47.18 ± 8.06
控制组	做检查	普通发烧	42	5.95 ± 2.32	35.40 ± 10.97
	做检查	淋巴细胞白血病	38	7.13 ± 1.61	41.05 ± 9.41
	不做检查	普通发烧	38	5.21 ± 2.04	34.39 ± 8.31
	不做检查	淋巴细胞白血病	36	7.78 ± 1.40	45.64 ± 8.22

反驳文本	检查结果	n	道德判断得分	患方信任
反驳文本	检查结果	n	M ± SD	M ± SD
实验组	普通发烧	44	7.20 ± 1.49	41.57 ± 8.72
实验组	淋巴细胞白血病	39	8.44 ± 0.88	45.25 ± 7.58
控制组	普通发烧	42	6.62 ± 1.67	40.71 ± 7.26
控制组	淋巴细胞白血病	40	7.76 ± 1.25	45.17 ± 8.41