老年医学教学实践中“生前预嘱”与“安宁疗护”的学情分析  

Learning Situation Analysis on “Living Will” and “Hospice Care” in Teaching Practice of Geriatrics

作　　者：杨伟[1] 周蓉 王颖[3] 李彩霞 任延平[1] YANG Wei;ZHOU Rong;WANG Ying;LI Caixia;REN Yanping(Department of Geriatrics,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Medical Administration,Xi’an Eight Hospital,Xi’an 710061,China;Department of General Medicine,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院老年内一科,陕西西安710061 [2]西安市第八医院医务科,陕西西安710061 [3]西安交通大学第一附属医院全科医学科,陕西西安710061

出　　处：《中国医学伦理学》2023年第12期1376-1381,共6页Chinese Medical Ethics

基　　金：陕西省健康文化研究中心“‘生前预嘱’在医养结合中的医学伦理学问题研究”(JKWH2019-Y07);西安交通大学第一附属医院2022教改课题重大项目“以‘核心胜任力’为导向多维度老年医学人才培养模式研究”(JG2022-0102)。

摘　　要：目的 调查老年医学不同身份学员对“生前预嘱、安宁疗护”的认知现状,为老年医学相应版块教学改进提供依据。方法 对参与老年医学特定课程的426名学员,采用在线问卷的方式收集数据并比较其不同问题认知的差异。结果 在“生前预嘱”概念了解与否方面,不同身份学员差异无统计学意义(χ^(2)=5.84,P=0.054),在“安宁疗护”概念方面,老年科医生及全科医生较医学本科生具有更多的了解(χ^(2)=37.932,P<0.001);全科医生较其他两类人群在决定自己希望使用或不使用生命支持治疗选择上自主选择较低,差异具有统计学意义(χ^(2)=28.737,P<0.001);对“签署生前预嘱”的认识方面全科医生与医学本科生差异具有统计学意义(χ^(2)=12.75,P=0.01)。结论 “生前预嘱”和“安宁疗护”在医学本科及继续教育的人文课程中需要加强推广,在普通大众人群中加强普及宣传力度,为提高安宁疗护质量做好铺垫工作。Objective:To investigate the cognitive status of “living will” and “hospice care” among geriatrics students with different identities,and to provide a basis for improving teaching in corresponding sections of geriatric medicine.Methods:An online questionnaire was used to collect data from 426 students participating in specific courses in geriatric medicine and compare their differences in understanding of different issues.Results:There was no statistically significant difference in the understanding of the concept of “living will” among students with different identities(χ^(2)=5.84,P=0.054).In terms of the concept of “hospice care”,geriatricians and general practitioners had a better understanding than that of medical undergraduates(χ^(2)=37.932,P<0.001).Compared to geriatricians and medical undergraduates,general practitioners had a lower level of autonomy in deciding whether to use life support treatment,and the difference was statistically significant(χ^(2)=28.737,P<0.001).There was a statistically significant difference between general practitioners and medical undergraduates in the understanding of “signing living will”(χ^(2)=12.75,P=0.01).Conclusion:The promotion of “living will” and “hospice care” in humanities courses of medical undergraduate and continuing medical education needs to be strengthened,and the popularization and publicity among the general public should be enhanced to lay the groundwork for improving the quality of hospice care.

关 键 词：生前预嘱 安宁疗护 老年医学 医学本科教育 

分 类 号：R-052[医药卫生]