晚期癌症患者的替代决策者姑息照护决策冲突的调查研究

doi:10.3761/j.issn.0254-1769.2022.14.003

摘要/Abstract

摘要：

目的调查晚期癌症患者的替代决策者姑息照护决策冲突现状并分析其影响因素。方法 2020年10月—2021年5月,使用便利抽样法,选取在某三级甲等医院就诊的235名晚期癌症患者的替代决策者作为调查对象。使用一般资料调查表、决策冲突量表、临终关怀认知问卷、一般自我效能感量表进行调查。结果晚期癌症患者的替代决策者决策冲突量表得分为（40.19±9.15）分,91.9%的替代决策者选择姑息照护时存在决策冲突,其中高水平决策冲突高达58.7%。决策冲突水平与临终关怀认知、一般自我效能感水平呈负相关（r=-0.505,-0.550,P<0.05）。多元线性回归分析结果显示,替代决策者年龄、职业、照顾临终患者经历、疾病了解程度、临终关怀认知、一般自我效能感是其决策冲突的影响因素。结论癌症患者替代决策者姑息照护决策冲突处于中高水平,存在决策延迟、决策后悔等情况;替代决策者高龄、无稳定工作、无医疗知识相关背景、有临终照护经历、对疾病了解较少者决策冲突水平更高;提高临终关怀认知、一般自我效能感水平有助于降低替代决策者决策冲突水平。

关键词: 替代决策者, 决策冲突, 姑息照护, 影响因素分析, 肿瘤护理

Abstract:

Objective To investigate the status of palliative care decision conflict among substitutive decision makers of advanced cancer patients,and to analyze the influencing factors. Methods Substitutive decision makers were selected by convenience sampling method from 235 patients with advanced cancer who were admitted to a tertiary A hospital. The general information questionnaire,decisional conflict scale,hospice care cognition questionnaire,and general self-efficacy scale were used for investigation. Results The decision-making conflict score of the substitutive decision makers was（40.19±9.15）,and 91.9% of the substitutive decision makers had decision-making conflicts when choosing palliative care,among which 58.7% reached the high level. The level of decision conflict was negatively correlated with the cognition of hospice care and general self-efficacy（r=-0.505,-0.550,P<0.05）. The results of multiple linear regression analysis showed that the age,occupation,experience of caring for terminally ill patients,disease understanding,hospice care cognition,and general self-efficacy of the substitutive decision makers were the influencing factors of their decision conflicts. Conclusion The decision-making conflicts of palliative care among substitutive decision makers of cancer patients are at a middle and high level,and there are such situations as decision-making delay and decision-making regret. The level of decision-making conflict was higher among the substitutive decision-makers who were aged,without stable work,without related background of medical knowledge,with hospice care experience,and knew little about the disease. Improving the awareness of hospice care and general self-efficacy can be conducive to reduce the decision-making conflict level of substitutive decision makers.

Key words: Substitutive Decision Makers, Decision Conflict, Palliative Care, Route Cause Analysis, Onco-logic Nursing

赵丽华, 屈欢, 李娇娇, 黄婷婷, 姜桂春. 晚期癌症患者的替代决策者姑息照护决策冲突的调查研究[J]. 中华护理杂志, 2022, 57(14): 1683-1689.

ZHAO Lihua, QU Huan, LI Jiaojiao, HUANG Tingting, JIANG Guichun. Analysis on status and influencing factors of palliative care decisions conflict among substitutive decision-makers of advanced cancer patients[J]. Chinese Journal of Nursing, 2022, 57(14): 1683-1689.

图/表 4

表1 不同特征替代决策者决策冲突量表得分的比较（n=235）

Table 1 Comparison of decision conflict scores of alternative decision makers with different characteristics（n=235）

表2 不同特征患者对替代决策者决策冲突得分的影响（n=235）

Table 2 Comparison of decision conflict scores of alternative decision makers in patients with different characteristics（n=235）

表3 自变量赋值表

Table 3 Independent variable assignment table

表4 替代决策者决策冲突的多元线性回归分析（n=235）

Table 4 Multivariate linear regression analysis of decision conflict for alternative decision makers（n=235）

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