家属对晚期肿瘤患者实施预立医疗照护计划态度的质性研究  

Attitudes toward advance directives for medical care in family members of advanced cancer patients:a qualitative study

作　　者：王丽英[1] 陆箴琦[2] 胡雁[1] 顾文英[2] 

机构地区：[1]复旦大学护理学院,上海200032 [2]复旦大学附属肿瘤医院

出　　处：《护理学杂志》2012年第17期47-50,共4页

基　　金：复旦大学护理学院科研基金资助项目(FNF 201013);复旦大学研究生创新基金资助项目(EZF400301)

摘　　要：目的了解家属对晚期肿瘤患者实施预立医疗照护计划的态度,为姑息照护领域相关医疗决策的制定提供依据。方法对17名晚期肿瘤患者家属进行深度访谈,采用现象学分析法分析资料。结果家属对预立医疗照护计划的态度提炼出4个主题:如患者主动提出,自己愿意支持;预立医疗照护计划本意较好,但不忍患者面对;预立医疗照护计划本身存在一定缺陷,效果令人质疑;目前实施有难度,将来有望推广。家属对晚期肿瘤患者终末治疗的选择提炼出2个主题:不忍患者受苦,选择放弃抢救;进退两难,抢救为无奈之举。结论晚期肿瘤患者家属在认可预立医疗照护计划的同时存在很多顾虑,知晓抢救的无效性但因外在压力和良心不安选择抢救;医护人员应做好家属健康教育,并协助家属与患者、家属与家属之间进行坦诚沟通,以推广预立医疗照护计划的理念。Objective To explore attitudes toward advance directives（ADs） for medical care in family members of advanced cancer patients,and to provide guidance for medical policy-making in palliative care.Methods Seventeen family members of advanced can-cer patients participated in the semi-structure interviews.Data were analyzed by using Claizzi′s phenomenological procedure.Results The data revealed four themes about family members′ attitudes toward ADs： they would support ADs if patients proposed;though ADs had many benefits,they could not stand patients facing it;they doubted effects of ADs for it showed many defects;they thought that it was difficult to implement ADs right now,but the situation would change in the future.Family members′ decision-making about life-sustaining treatment were concluded into two perspectives： they would give up life-sustaining treatment to decrease patients′ pain;they were in dilemma as they felt ashamed to give up treatment and had no choice but withholding life-sustaining therapy.Conclusion Although family members of advanced cancer patients approbate ADs,they are concerned and in dilemma that on one hand they understand uselessness of treatment,on the other hand,they have to make decisions to withhold life-sustaining therapy because of external stress and internal stress of self-guilt.Medical staffs should strengthen education on family members and help them communicate with patients and other relatives,so as to make the concept of ADs widely accepted.

关 键 词：晚期肿瘤 预立医疗照护计划 生命意愿 姑息照护 质性研究 

分 类 号：R473.73[医药卫生—护理学]