Abstract:

Objective To establish a hospital-community-home three-level linkage palliative care service model （hereinafter referred to as palliative care service model） for patients with advanced tumor,and to promote the development of regional palliative care. Methods On the basis of the literature research and expert group meeting,the initial draft of the palliative care service model was constructed. 20 palliative care experts were invited to conduct 2 rounds of correspondence to revise the items. The constructed palliative care service model was preliminary applied in 10 cases of tumor patients. Results The effective recovery rates of 2 rounds of question-naires are 100%. The second round of expert judgment coefficients was 0.84;the degree of familiarity of the experts was 0.91;the degree of authority was 0.93;the Kendall harmonic coefficient was 0.086~ 0.193. The finally formed palliative care service model includes 7 first-level indicators（model purpose,implementation agency,organiza-tional structure and time limitation,job responsibilities and requirements,implementation methods,core service content,evaluation and continuous improvement）,24 second-level indicators,30 third-level indicators and 19 fourth-level indicators. Conclusion The palliative care service model constructed in this study is comprehensive and scien-tific,and it can provide references for the whole-process care model of patients with advanced tumors in the region.

Key words: Hospice Care, Hospital-Community-Home, Three-Level Linkage, Delphi Technology, Oncologic Nursing

摘要：

目的 构建晚期肿瘤患者医院-社区-居家三级联动安宁疗护模式（以下简称安宁疗护模式）,推进区域安宁疗护协同发展。 方法 在文献研究和专家小组会议的基础上,构建安宁疗护模式初稿,采用德尔菲法,邀请20名安宁疗护专家进行2轮函询,按照专家函询意见对条目进行修改。将构建的安宁疗护模式在10例肿瘤患者中进行初步应用。 结果 2轮问卷有效回收率均为100%。第2轮专家判断系数为0.84,专家熟悉程度系数为0.91,专家权威程度系数为0.93,肯德尔和谐系数为0.086~0.193。最终形成的安宁疗护模式包含7个一级指标（模式目的、实施机构、组织结构及时间界定、岗位职责及要求、服务模式实施途径、核心服务内容、评价与持续改进）、24个二级指标、30个三级指标和19个四级指标。10例肿瘤患者初步应用效果良好。 结论 该研究构建的安宁疗护模式内容全面、科学可靠,可为推动区域内晚期肿瘤患者全程照护服务提供借鉴和参考。

关键词: 安宁疗护, 医院-社区-居家, 三级联动, 德尔菲技术, 肿瘤护理