Table_1_Job Burnout Is Associated With Prehospital Decision Delay: An Internet-Based Survey in China.DOCX

BackgroundPrehospital delay is associated with non-modifiable factors such as age, residential region, and disease severity. However, the impact of psychosocial factors especially for job burnout on prehospital decision delay is still little understood.
MethodThis internet-based survey was conducted between 14 February 2021 and 5 March 2021 in China through the Wechat platform and web page. Self-designed questionnaires about the expected and actual length of prehospital decision time and the Chinese version of Maslach Burnout Inventory-General Survey, Type D Personality Scale-14, and Social Support Rating Scale were applied. A total of 1,039 general participants with a history of perceptible but tolerable body discomfort were included.
ResultsThe top six reasons for prehospital decision delay were: (1) endure until self-healing (50.7%), (2) too busy to ask for leave (40.3%), (3) process for seeing a doctor too complicated (35.8%), (4) too tired after work (26.2%), (5) worry about the expenditure (16.6%), and (6) fear of being identified as with serious problem (14.5%). The univariate analyses revealed that older age (p = 0.001), type D personality (p = 0.025), job burnout (p = 0.055), and worrying about expenditure (p = 0.004) were associated with prolonged prehospital decision time, while engaged in medical-related job (p = 0.028) and with more social support (p = 0.066) would shorten the delay. The multivariate analysis using logistic regression model with forward selecting method showed that age [per 10 years, odds ratio (OR) 1.19 (1.09–1.31), p < 0.001], job burnout [per 10 points in Maslach Burnout Inventory-General Survey (MBI-GS), OR 1.17 (1.04–1.31), p = 0.007], and worrying about expenditure [OR 1.75 (1.25–2.47), p = 0.001] were the three determinants for prehospital decision delay (>7 days). Mediating effects were analyzed by using bias-corrected percentile bootstrap methods (N = 10,000). Social support was found partially mediated the relationship between the determinants and prehospital decision time. The partial mediating effect of social support accounted for 24.0% of the total effect for job burnout and 11.6% for worrying about expenditure.
ConclusionPsychosocial factors have a non-negligible impact on prehospital decision delay. The crucial part of prehospital decision delay may be the lack of motivation inside. Job burnout and lack of social support, as two commonly seen features in the modern world, should be given enough consideration in disease prevention and treatment.

研究背景 院前决策延迟与年龄、居住地区、疾病严重程度等不可改变的因素相关。然而，社会心理因素尤其是职业倦怠对院前决策延迟的影响仍未得到充分阐明。
研究方法 本研究于2021年2月14日至2021年3月5日在中国境内通过微信平台及网页开展线上问卷调查。采用自行设计的院前决策预期时长与实际时长问卷，以及汉化版马氏倦怠量表通用版（Maslach Burnout Inventory-General Survey, MBI-GS）、D型人格量表-14（Type D Personality Scale-14）和社会支持评定量表进行调研。最终纳入1039名曾出现可感知但可耐受躯体不适的普通受试者。
研究结果 院前决策延迟的前六大诱因依次为：(1) 坚持等待自愈（50.7%）；(2) 工作繁忙无法请假（40.3%）；(3) 就诊流程过于繁琐（35.8%）；(4) 下班后过度疲惫（26.2%）；(5) 担忧医疗费用（16.6%）；(6) 害怕被诊断为严重疾病（14.5%）。单因素分析结果显示，年龄较大（p=0.001）、D型人格（p=0.025）、职业倦怠（p=0.055）以及担忧医疗费用（p=0.004）与院前决策延迟时间延长显著相关；而从事医疗相关职业（p=0.028）与更高水平的社会支持（p=0.066）则可缩短决策延迟时长。采用向前筛选法的logistic回归多因素分析结果显示，年龄[每增加10岁，比值比（odds ratio, OR）=1.19，95%置信区间（1.09~1.31），p<0.001]、职业倦怠[马氏倦怠量表通用版（MBI-GS）每升高10分，OR=1.17，95%置信区间（1.04~1.31），p=0.007]以及担忧医疗费用（OR=1.75，95%置信区间1.25~2.47，p=0.001）是导致院前决策延迟（>7天）的三大独立危险因素。采用偏差校正百分位Bootstrap法（样本量N=10000）进行中介效应分析，结果显示社会支持在上述危险因素与院前决策时长之间存在部分中介效应。其中，社会支持对职业倦怠与院前决策延迟的中介效应占总效应的24.0%，对担忧医疗费用与院前决策延迟的中介效应占总效应的11.6%。
研究结论 社会心理因素对院前决策延迟具有不可忽视的影响。院前决策延迟的核心诱因可能源于个体内在动机的缺失。职业倦怠与社会支持不足作为现代社会的两大常见问题，在疾病防治工作中应得到足够的重视。