家庭照顾者对老年患者死亡地点的选择倾向及相关因素研究  

Study on family caregiver’s choice preference of elderly patients’ death place and its related factors

作　　者：杨子敬 舒晓 周玉兰 陈茜[1,2,3,4] YANG Zijing;SHU Xiao;ZHOU Yulan;CHEN Qian(Geriatrics Center,West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China;West China School of Nursing,Sichuan University,Chengdu 610041,Sichuan,China;National Clinical Research Center for Geriatrics,West China Hospital of Sichuan University,Chengdu 610041,Sichuan,China;Sichuan Key Laboratory of Nursing,Chengdu 610041,Sichuan,China)

机构地区：[1]四川大学华西医院老年医学中心,四川成都610041 [2]四川大学华西护理学院,四川成都610041 [3]四川大学华西国家老年疾病临床研究中心,四川成都610041 [4]护理学四川省重点实验室,四川成都610041

出　　处：《护士进修杂志》2023年第3期193-198,共6页Journal of Nurses Training

基　　金：国家自然科学基金(编号:7227117);四川省科技厅项目(编号:2022YFS0267);四川省干部保健科研课题(编号:川干研2022-104)。

摘　　要：目的 探索家庭照顾者对老年患者死亡地点的选择倾向及相关因素。方法 采用便利抽样法选取2019年1月—2020年1月于四川大学华西医院老年医学科就诊的住院患者的278位照顾者,以自制调查表调查照顾者对老年患者死亡地点的选择倾向及相关因素。结果 照顾者对患者死亡地点选择在家里的占28.1%,在医院或养老机构等占71.9%,选择非居家离世的主要原因为担心其不利于患者的医疗或护理(53.2%)。单因素分析发现不同学历、职业、宗教信仰、与患者的关系、生前预嘱知晓情况、终末期是否为患者选择安宁疗护及对终末期抢救影响生存质量看法不同的照顾者对患者死亡地点选择倾向不同(P<0.01);多因素分析提示,终末期抢救会影响生存质量是照顾者选择老年患者在家离世的促进因素,学历高、职业为管理者及技术人员、知晓生前预嘱是选择在家死亡的影响因素(P<0.05)。结论 死亡地点是衡量患者死亡质量的重要因素,多数照顾者选择让老年患者在医院离世。医护人员应帮助终末期老年患者照顾者充分了解病情并尊重患者意愿,促使医、患、家属共同做出合适的决策;普及并发展居家或社区安宁疗护是提高患者死亡质量的重要途径。Objective To explore the preference of family caregivers when choosing the death place of elderly patients and its related factors. Methods The caregivers of patients who were hospitalized in the Department of Geriatrics, West China Hospital of Sichuan University from January 2019 to January 2020 were recruited by convenience sampling. A self-made questionnaire was used to investigate the caregivers’ preference for the death place of elderly patients and other related factors. Results 28.1% of the caregivers prefer to choose to let their patients die at home, while 71.9% of them choose hospitals or nursing facilities. The main reason for choosing to die outside of the home was worrying about unfavorable medical care(53.2%). Univariate analysis showed that caregivers with different education background, occupation, religious belief, relationship with patients, knowledge of living wills, and views of terminal rescue affecting quality of life had different preferences on the place of death of patients(P<0.01).Multivariate analysis showed that terminal rescue affecting quality of life was the promoting factor for caregivers to choose to let patients die at home, while highly educated, professional managers and technicians, and knowing the advance directives were obstacle factors for choosing home death(P<0.05). Conclusion The place of death is an important factor in measuring the quality of patient death, and most caregivers choose to let elderly patients die in the hospital. Medical staff should help caregivers of terminally ill elderly patients to fully understand the condition and respect the patient’s wishes, so as to encourage doctors, patients, and family members to make appropriate decisions together. Also, popularizing and developing home or community tranquility care is an important way to improve the quality of patient death.

关 键 词：临终护理 老年人 照顾者 死亡质量 死亡地点 安宁疗护 

分 类 号：R48[医药卫生—临床医学] R473