Abstract:

Objective To construct a decision support education program for the family members of patients with advanced cancer and to investigate its application effects，so as to improve understanding and acceptance of hospice care for family members of advanced cancer patients. Methods Using the Ottawa Decision Support Framework as a theoretical guide，the program was initially drafted based on a literature review，qualitative interview and expert consultation. From September 2023 to January 2024，a convenience sampling method was used to select patients’ families in a tertiary-level hospital in Tianjin as the research subjects，and they were randomly divided into an experimental group and a control group. The experimental group received the decision support education program in addition to routine care，while the control group received routine care. Family members’ knowledge about hospice，the scores on the Death Attitude Profile Scale，and their willingness to choose hospice care were compared before and after the interventions. Results The program finally included 4 first-level items，15 second-level items，and 59 third-level items. During the program implementation phase，4 cases withdrew from the study，resulting in 46 cases in the experimental group and 47 cases in the control group. After intervention，the experimental group had higher scores on hospice knowledge and positive attitude towards death than the control group，while scores on negative attitude towards death were lower（P<0.05）；their willingness to choose hospice care for themselves and for the patients was higher than that of the control group（P<0.05）. Conclusion The hospice care decision support education program is scientific，feasible and practical，which can improve the knowledge of hospice care of the family members，improve their attitude towards death，and ultimately improve their willingness to choose hospice care.

Key words: Cancer, Family Members, Hospice Care, Decision Support, Health Education, Nursing Care

摘要：

目的 构建晚期癌症患者家属安宁疗护决策支持教育方案并探讨其应用效果，旨在提高家属对安宁疗护的认知水平及接受度。方法 以渥太华决策支持框架为理论指导，基于文献回顾、质性访谈及专家函询结果拟订方案。采用便利抽样法，选取2023年9月—2024年1月在天津市某三级甲等医院住院的晚期癌症患者的家属作为研究对象，采用随机数字表法分为试验组48名和对照组49名。试验组在常规护理的基础上应用安宁疗护决策支持教育方案进行干预，对照组实施常规护理。比较两组干预前后的安宁疗护知识水平、死亡态度以及安宁疗护的选择意愿。结果 最终构建的方案包括4个一级条目、15个二级条目、59个三级条目。在方案应用阶段，有4名家属主动退出研究，最终试验组纳入46名、对照组47名。干预后，试验组安宁疗护知识水平高于对照组，正向死亡态度得分高于对照组，负向死亡态度得分低于对照组，差异均具有统计学意义（P<0.05）；试验组为自己及患者选择安宁疗护的意愿均高于对照组，差异具有统计学意义（P<0.05）。结论 该研究构建的方案具有科学性、可行性，实施该方案可以提高晚期癌症患者家属的安宁疗护知识水平、改善其死亡态度，提高家属对安宁疗护的选择意愿。

关键词: 癌症, 家属, 安宁疗护, 决策支持, 健康教育, 护理