关键词: 晚期癌症, 预立医疗照护计划, 照顾者, 三元交互决定论, 安宁疗护

Abstract:

Objective To understand the barriers of surrogate decision-makers participating in the advanced care planning（ACP） for patients with advanced cancer，and to provide references for the construction and intervention of educational programs. Methods Under the guidance of ternary reciprocal determinism，qualitative research method was used to conduct semi-structured interviews with 12 surrogate decision makers of advanced cancer patients in 2 tertiary hospitals of Zhejiang Province，and the data was analyzed using targeted content analysis. Results Based on the theory，the influencing factors of participating in ACP of the surrogate decision-makers of patients with advanced cancer were summarized into 3 themes：individual level-dual restriction of subjective thought and objective ability（value restriction，cognitive understanding deviation，economic condition restriction，patient’s situation control），environment level-synergistic influence of medical environment and social environment（limited medical conditions，pressure from public moral opinion，insufficient policy guarantee，lack of family consensus），behavior level - interaction of external guidance and internal feedback（lack of guidance of medical staff，experience support of medical decision-making）. Conclusion Surrogate decision-makers of patients with advanced cancer face many pressures before participating in the ACP. Under the guidance of the theory of knowledge，belief and practice，medical staff can give them pre-established medical care knowledge to correct their cognitive bias. Medical staff can guide the realization of “family-centered” decision-making mode to strengthen the family support of surrogate decision-makers. Medical staff also can lead the establishment of a surrogate decision-makers support group to share decision-making experience and provide medical decision-making assistance.

Key words: Advanced Cancer, Advanced Care Planning, Caregiver, Ternary Reciprocal Determinism, Palliative Care