老年住院患者对预立医疗照护计划沟通的偏好研究及护理启示

doi:10.3761/j.issn.0254-1769.2025.18.003

摘要/Abstract

摘要：

目的探究老年住院患者对预立医疗照护计划（advance care planning，ACP）的沟通偏好，为提高ACP开展率提供参考。方法采用便利抽样法，于2023年4—11月选取温州市某三级甲等医院的老年住院患者作为调查对象，采用一般资料收集表、自制的ACP沟通偏好问卷进行面对面调查，采用混合Logit模型、支付意愿分析、相对重要性分析及亚组分析探究老年住院患者对ACP的沟通偏好。结果发放问卷204份，回收有效问卷200份，有效问卷回收率为98.04%。混合Logit模型分析结果显示，沟通时机、沟通形式、家属是否参与ACP沟通、ACP文书有无法律效力及自付费用等关键属性会影响老年住院患者对ACP的沟通偏好（P<0.05）。支付意愿分析结果显示，沟通时机、沟通形式、家属是否参与ACP沟通3个属性发生转变时，患者的支付意愿会发生改变。相对重要性分析结果显示，重要性排序前3位的依次为沟通时机、沟通形式与家属是否参与ACP沟通。亚组分析结果显示，性别、受教育程度及居住地会影响老年住院患者对ACP的沟通偏好（P<0.05）。结论 ACP沟通的关键属性会影响老年住院患者对ACP的开展及支付意愿，且不同特征老年住院患者对ACP的沟通偏好不同。医护人员应根据患者的偏好以及个人特征，制订最佳沟通方案。

关键词: 老年人, 住院患者, 预立医疗照护计划, 偏好研究, 离散选择实验, 安宁疗护

Abstract:

Objective To explore the communication preferences for advance care planning（ACP） among elderly hospitalized patients and to provide references for improving the ACP implementation rate. Methods Convenience sampling was used to select elderly hospitalized patients from a tertiary hospital in Wenzhou City between April and November 2023. Face-to-face surveys were conducted using a general data collection form and a self-designed questionnaire on ACP communication preferences. Mixed Logit Model，willingness-to-pay analysis，relative importance analysis，and subgroup analysis were employed to explore preferences. Results 204 questionnaires were distributed and 200 valid questionnaires were recovered，with a valid questionnaire response rate of 98.04%. The Mixed Logit Model analysis indicated that key attributes—communication timing，communication form，family participation in ACP communication，legal validity of ACP documents，and out-of-pocket costs—significantly influenced preferences（P<0.05）. Willingness-to-pay analysis showed that changes in communication timing，communication form，and family participation altered patients’ willingness to pay. Relative importance analysis ranked the top 3 attributes as communication timing，communication form，and family participation. Subgroup analysis revealed that gender，education level，and residence location affected preferences（P<0.05）. Conclusion Key attributes of ACP communication affect elderly hospitalized patients’ preferences and willingness to pay，with variations across subgroups. Healthcare professionals should develop optimal communication programs based on patient preferences and individual characteristics.

Key words: Elderly, Hospitalized Patients, Advance Care Planning, Preference Research, Discrete Choice Experiment, Palliative Care

盛智琼, 任桢, 刘冰凝, 丁燕洁, 李书寰, 刘钰文, 黄思媛, 孙彩霞. 老年住院患者对预立医疗照护计划沟通的偏好研究及护理启示[J]. 中华护理杂志, 2025, 60(18): 2191-2196.

SHENG Zhiqiong, REN Zhen, LIU Bingning, DING Yanjie, LI Shuhuan, LIU Yuwen, HUANG Siyuan, SUN Caixia. Study of communication preferences for advance care planning in elderly hospitalized patients and nursing implications[J]. Chinese Journal of Nursing, 2025, 60(18): 2191-2196.

图/表 3

表1 老年住院患者对预立医疗照护计划沟通偏好的属性及水平描述

Table 1 Attributes and levels of description of communication preferences for advance care planning among elderly hospitalized patients

表2 调查对象的一般资料（n=194）

Table 2 Demographic information of the survey participants（n=194）

表3 老年住院患者对预立医疗照护计划沟通偏好的混合Logit模型分析结果（n=194）

Table 3 Results of a mixed Logit model of elderly hospitalized patients’ preferences for the communication of advance care planning（n=194）

参考文献 16

[1]	焦思涵. 临终关怀在我国发展的伦理困境研究[D]. 锦州: 锦州医科大学, 2017.
	Jiao SH. Research on ethical dilemma of hospice care in China[D]. Jinzhou: Jinzhou Medical University, 2017.
[2]	杨希, 王冰冰, 谢淑萍, 等. 基于CiteSpace软件对预立医疗照护计划相关文献的计量可视化分析[J]. 护理与康复, 2022, 21(6):38-43.
	Yang X, Wang BB, Xie SP, et al. Bibliometric and visualized analysis on related literature on advance care planning based on CiteSpace software[J]. J Nurs Rehabil, 2022, 21(6):38-43.
[3]	魏利荣, 刘云, 边继萍, 等. 护理人员对预立医疗照护计划认知与感受的Meta整合[J]. 中华护理杂志, 2022, 57(22):2784-2790. DOI
	Wei LR, Liu Y, Bian JP, et al. The perception and feeling of nursing staff in advance care planning:a Meta-synthesis of qualitative research[J]. Chin J Nurs, 2022, 57(22):2784-2790.
[4]	邓志坚, 陈相应, 杨柳, 等. 癌症患者及家属参与预立医疗照护计划体验质性研究的Meta整合[J]. 中华护理杂志, 2020, 55(12):1864-1870. DOI
	Deng ZJ, Chen XY, Yang L, et al. The experience of cancer patients and their relatives in advance care planning:a meta-synthesis of qualitative research[J]. Chin J Nurs, 2020, 55(12):1864-1870.
[5]	沈姞, 武文斌, 刘洋, 等. 老年住院患者及家属对预立医疗照护计划的态度及其影响因素[J]. 中华老年医学杂志, 2020, 39(6):653-657.
	Shen J, Wu WB, Liu Y, et al. Attitudes towards advance-care planning and its influencing factors among elderly inpatients and their family members[J]. Chin J Geriatr, 2020, 39(6):653-657.
[6]	戴静, 张会君. 住院老年HIV/AIDS患者预立医疗照护计划接受度及影响因素分析[J]. 中国艾滋病性病, 2021, 27(6):598-601.
	Dai J, Zhang HJ. Acceptance and influencing factors of advance care planning for hospitalized elderly patients with HIV/AIDS[J]. Chin J AIDS STD, 2021, 27(6):598-601.
[7]	刘丽, 张帅, 胡秀英. 四川省老年人护理需求及服务的调查研究[J]. 中华护理杂志, 2023, 58(19):2339-2344. DOI
	Liu L, Zhang S, Hu XY. A survey and analysis on current status of the need and service for geriatric nursing in Sichuan Province[J]. Chin J Nurs, 2023, 58(19):2339-2344. DOI
[8]	Zhang N, Ning XH, Zhu ML, et al. Attitudes towards advance care planning and healthcare autonomy among community-dwelling older adults in Beijing,China[J]. Biomed Res Int, 2015,2015, 20(15):1-10.
[9]	冷安丽. 晚期癌症患者对临终关怀的选择偏好研究[D]. 济南: 山东大学, 2019.
	Leng AL. Study on the choice preference of terminal cancer patients for hospice care[D]. Jinan: Shandong University, 2019.
[10]	de Bekker-Grob EW, Donkers B, Jonker MF, et al. Sample size requirements for discrete-choice experiments in healthcare:a practical guide[J]. Patient, 2015, 8(5):373-384. DOI PMID
[11]	Rietjens JAC, Sudore RL, Connolly M, et al. Definition and recommendations for advance care planning:an international consensus supported by the European Association for Palliative Care[J]. Lancet Oncol, 2017, 18(9):e543-e551.
[12]	王心茹, 绳宇. 预立医疗照护计划准备度量表的编制及信度效度研究[J]. 中国护理管理, 2019, 19(6):861-867.
	Wang XR, Sheng Y. Development and validation of Advance Care Planning Readiness Scale[J]. Chin Nurs Manag, 2019, 19(6):861-867.
[13]	Van Scoy LJ, Green MJ, Reading JM, et al. Can playing an end-of-life conversation game motivate people to engage in advance care planning?[J]. Am J Hosp Palliat Care, 2017, 34(8):754-761. DOI PMID
[16]	Yan YX, Shen BY, Li SP, et al. Research progress on game education in advance care planning for end-of-life patients[J]. Chin J Nurs Educ, 2022, 19(1):86-91.
[17]	李子芬, 彭楚君. 推动“以家庭为中心”的预立医疗照护计划[J]. 中国护理管理, 2019, 19(3):326-329.
	Li ZF, Peng CJ. Promoting family-centered advance care planning in China[J]. Chin Nurs Manag, 2019, 19(3):326-329.
[18]	邓仁丽, 陈柳柳, 史宝欣, 等. 中国文化背景下预立医疗照护计划的研究进展[J]. 中华护理杂志, 2015, 50(9):1117-1121.
	Deng RL, Chen LL, Shi BX, et al. Research progress of pre-established medical care plan under the cultural background of China[J]. Chin J Nurs, 2015, 50(9):1117-1121.
[14]	杨琴, 雷静, 李江平. 受教育程度和家庭经济水平的交互作用对城市居民医疗卫生服务满意情况的影响[J]. 宁夏医科大学学报, 2022, 44(1):67-72,78.
	Yang Q, Lei J, Li JP. The influence of the interaction between education level and family economic level on the satisfaction of medical and health services of urban residents[J]. J Ningxia Med Univ, 2022, 44(1):67-72,78.
[15]	Liu L, Zhao YY, Yang C, et al. Gamification for promoting advance care planning:a mixed-method systematic review and meta-analysis[J]. Palliat Med, 2021, 35(6):1005-1019.
[16]	颜逸霞, 沈波涌, 李莎萍, 等. 游戏教育在终末期患者预立医疗照护计划中的应用进展[J]. 中华护理教育, 2022, 19(1):86-91.