癌症晚期患者代理决策者预立医疗照护计划参与度影响因素的混合方法系统评价  

Influencing Factors of Advance Care Planning Participation in Surrogate Decision Maker of Advanced Cancer Patients:a Mixed Methods Systematic Review

作　　者：韩知浩 马小琴[1] HAN Zhihao;MA Xiaoqin(College of Nursing,Zhejiang Chinese Medical Univeisity,Hangzhou 310053,China)

机构地区：[1]浙江中医药大学护理学院,浙江省杭州市310053

出　　处：《中国全科医学》2023年第22期2785-2792,共8页Chinese General Practice

基　　金：2023年浙江省医药卫生科技计划项目(2023KY846)。

摘　　要：背景 国内关于癌症晚期患者代理决策者预立医疗照护计划(ACP)的研究尚处于起步阶段,相关研究较为碎片化且针对性不强,缺乏对其影响因素的系统化分析。目的 系统评价癌症晚期患者代理决策者ACP参与度的影响因素,为该领域的后续研究提供参考。方法 本研究为混合方法系统评价。于2022年4月,通过计算机检索中国知网、万方数据知识服务平台、PubMed、EmBase、the Cochrane Library、Web of Science、中国生物医学文献数据库(CBM)获取癌症晚期患者代理决策者ACP参与度影响因素相关的研究。检索时限为各数据库建库至2022-07-01。对纳入的研究进行文献质量评价并提取资料后,采用乔安娜布里格斯研究所(JBI)混合系统评价指南推荐的方法,将定量研究与定性研究分别提取数据后进行整合,归纳主题,得到最终代理决策者ACP参与度的影响因素。结果 经文献筛选及文献质量评价后共纳入11篇文献,5篇为质性研究,6篇为横断面研究。整合定量研究和定性研究的分析结果后,最终形成个人因素、外部支持、信息获取、疾病状况4类整合结果,共提取宗教信仰与宗族文化、社会网络、ACP了解度、疾病发展预期等22个影响因素。结论 癌症晚期患者代理决策者ACP参与度的影响因素是多方面的。公众认知、沟通交流、政策法规及代理决策者的个人特征会影响其ACP的参与度。因此,应当通过加强相关宣教提高公众认知,建立患者-代理决策者-医疗卫生保健提供者的有效沟通机制,健全相关政策与法规保障,对可变因素加强引导及干预。Background The research field of advance care planning(ACP)for the surrogate decision makers of advanced cancer patients in China is still at the initial stage,and the relevant researches are fragmented and poorly targeted,lacking systematic analysis of the influencing factors.Objective To systematically review the influencing factors of ACP participation in surrogate decision makers of advanced cancer patients,so as to provide a reference for subsequent researches in this field.Methods This study was a mixed-methods systematic review.In April 2022,CNKI,Wanfang Data Knowledge Service Platform,PubMed,EmBase,the Cochrane Library,Web of Science,and CBM were searched by computer for the studies related to influencing factors of ACP participation in surrogate decision makers of advanced cancer patients from the inception to 2022-07-01.After evaluating the quality of literature and extracting information from the included studies,the method of JBI Hybrid System Evaluation Guide was used to integrate quantitative studies and qualitative studies after extracting data separately,and then the themes were summarized,obtaining the influencing factors of the final ACP participation in surrogate decision makers.Results A total of 11 papers were included after literature screening and evaluation of literature quality,including 5 qualitative studies and 6 cross-sectional studies.The final results were integrated into 4 categories of personal factors,external support,information access,and disease status,involving 22 influencing factors such as religious beliefs and clan culture,social network,ACP understanding,and disease development expectation after integrating the analysis results of quantitative and qualitative studies.Conclusion There are multiple influencing factors of ACP participation in surrogate decision makers of advanced cancer patients.Public perception,communication,policies and personal characteristics of surrogate decision makers can affect their ACP participation.Therefore,relevant education should be strengthen

关 键 词：临终关怀医疗 预立医疗照护计划 临终病人 代理决策者 影响因素分析 混合方法系统评价 

分 类 号：R473[医药卫生—护理学] R197[医药卫生—临床医学]