血液肿瘤患者代理决策者预立医疗照护计划参与度及其影响因素研究  

Participation in Advance Care Planning and Associated Factors among Surrogate Decision Makers of Patients with Hematologic Malignancies

作　　者：王天航 王雯 沈文婷 史宝欣 WANG Tianhang;WANG Wen;SHEN Wenting;SHI Baoxin(Research Center of Hospice Care,Tianjin Medical University,Tianjin 300070,China;State Key Laboratory of Experimental Hematology/National Clinical Research Center for Blood Diseases,Institute of Hematology&Blood Diseases Hospital,CAMS&PUMC,Tianjin 300020,China)

机构地区：[1]天津医科大学临终关怀研究中心,天津市300070 [2]中国医学科学院血液病医院(中国医学科学院血液学研究所)实验血液学国家重点实验室,国家血液系统疾病临床医学研究中心,天津市300020

出　　处：《中国全科医学》2022年第7期859-866,共8页Chinese General Practice

摘　　要：背景预立医疗照护计划(ACP)的实施可以帮助患者在丧失决策能力时得到与其价值观、目标和偏好相符合的医疗、护理服务。在ACP实施过程中,代理决策者作为主要参与者,担任着重要角色。当前,国内有关血液肿瘤患者代理决策者ACP参与度现状及其影响因素的研究较少。目的了解血液肿瘤患者代理决策者ACP参与度现状并分析其影响因素,以期为本土化ACP实施策略的制定提供参考与依据,并在一定程度上促进ACP在国内的推广。方法采用便利抽样法,抽取2020年10月至2021年3月于中国医学科学院血液病医院接受治疗的235例血液肿瘤患者的代理决策者为研究对象。采用一般资料调查表、中文版代理决策者预立医疗照护计划参与调查问卷(C-ACP-17-SDM)、中文版疾病不确定感家属量表(C-MUIS-FM)、简易应对方式问卷(SCSQ)、社会支持评定量表(SSRS)对其进行调查,比较不同特征血液肿瘤患者代理决策者C-ACP-17-SDM得分情况,采用Pearson相关分析血液肿瘤患者代理决策者C-ACP-17-SDM得分与C-MUIS-FM、SCSQ、SSRS得分的相关性,采用多重线性回归分析血液肿瘤患者代理决策者ACP参与度的影响因素。结果235例血液肿瘤患者代理决策者C-ACP-17-SDM得分为(52.23±13.57)分,C-MUIS-FM得分为(66.43±12.54)分,SCSQ的积极应对维度得分为(24.34±6.94)分、消极应对维度得分为(9.87±4.25)分,SSRS总得分为(40.33±6.78)分。男性、参与过临终医疗决策、了解生命支持、听说过ACP的代理决策者的C-ACP-17-SDM得分相应地高于女性、未参与过临终医疗决策、不了解生命支持、未听说过ACP的代理决策者,差异有统计学意义(P<0.05)。血液肿瘤患者代理决策者C-ACP-17-SDM得分与C-MUIS-FM总得分及不明确性维度、缺乏澄清维度得分呈线性负相关,与SCSQ的积极应对维度得分呈线性正相关。血液肿瘤患者代理决策者性别、是否参与过临终医疗决策�Background Advance care planning(ACP)helps patients to obtain medical care meeting their values,goals and preferencesunder the circumstances of loss of decision-making ability.The surrogate decision maker(SDM)plays a key role as the main participantinvolved in the process of ACP.But there are no studies on the participation and role of SDMs in ACP process in China.Objective To investigate the participation in ACP of SDMs of patients with hematologic malignancies and its associated factors,providing a reference for the development of localized strategies for ACP implementation,and for the promotion of ACP in China.Methods Convenient sampling was used to select the SDMs of 235 patients with hematologic malignancies recruited from Blood Diseases Hospital,Chinese Academy of Medical Sciences during October 2020 to March 2021.They were invited to compete a survey using the Chinese version of the 17-item Advance Care Planning Engagement Survey for Surrogate Decision Makers(C-ACP-SDM-17),Chinese version of Mishel Uncertainty in Illness Scale-Family Member form(C-MUIS-FM),Simplified Coping Style Questionnaire(SCSQ),and Social Support Rating Scale(SSRS).The C-ACP-SDM-17 scores were compared by demographic factors of the SDMs.Pearson correlation analysis was used to explore the correlation of C-ACP-SDM-17 score with C-MUIS-FM,SCSQ,and SSRS scores of SDMs.Multiple linear regression was used to analyze the factors associated with the participation in ACP of SDMs.Results The average total scores of the C-ACP-SDM-17,C-MUIS-FM,and SSRS of the SDMs were(52.23±13.57),(66.43±12.54)and(40.33±6.78),respectively.And the average scores of two subscales of SCSQ of the SDMs,active coping and passive coping,were(24.34±6.94),and(9.87±4.25),respectively.Male,having experience of involvement in end-of-life medical decision making,awareness of life-sustaining treatment,and knowing of ACP were associated with statistically higher C-ACP-SDM-17 score of SDMs(P<0.05).The total C-ACP-SDM-17 score of SDMs was negatively correlated with the tot

关 键 词：血液肿瘤 预立医疗照护计划 代理决策 参与度 影响因素分析 

分 类 号：R733[医药卫生—肿瘤] R197.322[医药卫生—临床医学]