三级医院终末期患者转诊的家庭决策路径  

Family Decision-Making Path for the Referral of Terminal Patients in Tertiary Hospitals

作　　者：张珊 张晓天 岳鹏[1] 杨晶[3] 尹灼[4] ZHANG Shan;ZHANG Xiaotian;YUE Peng;YANG Jing;YIN Zhuo(School of Nursing,Capital Medical University,Beijing 100069,China;Nursing Department,Peking University Third Hospital,Beijing 100191,China;North Department of Cardiology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Respiratory and Critical Care Medicine,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]首都医科大学护理学院,北京100069 [2]北京大学第三医院护理部,北京100191 [3]中日友好医院北区心内科,北京100029 [4]中日友好医院呼吸与危重症医学科,北京100029

出　　处：《中国医学科学院学报》2024年第2期217-224,共8页Acta Academiae Medicinae Sinicae

基　　金：国家社会科学基金(22BSH150)。

摘　　要：目的深入了解三级医院终末期患者转诊中家庭决策的动机、模式及相关因素。方法采用目的抽样法选取北京市3家三级医院的终末期患者及家属作为研究对象,进行半结构式访谈,对访谈资料进行主题分析。结果根据主题饱和原则,最终纳入11例患者和15位家属。访谈资料经整理和分析后归纳为6大主题:决策前提、决策模式、家庭支持、转出医院方医疗团队支持、转诊通道状况、志愿者团队的介入及社会支持,在此基础上,构建终末期患者转诊的家庭决策流程图。结论深度剖析了三级医院终末期患者转诊中家庭决策的多方面因素,结果突显了内外在因素的重要性,同时强调了决策模式、家庭支持、医疗团队支持、转诊通道状况以及志愿者团队的介入和社会支持的综合影响,为改善终末期患者转诊流程和提升家庭决策的质量提供了深刻的理解,为未来改进医疗服务和决策支持提供了有益的建议。Objective To gain an in-depth understanding of the motivations,patterns,and related factors in family decision-making regarding the referral of terminal patients in tertiary hospitals.Methods Using purposive sampling,terminal patients and their family members from three tertiary hospitals in Beijing were selected as subjects.Semi-structured interviews were conducted,and the interview data were subjected to thematic analysis.Results Following the saturation principle,a total of 11 patients and 15 family members were included.The interview data were organized and analyzed,yielding six major themes:decision premises,decision patterns,family support,support from the referring hospital’s medical team,referral channel conditions,and involvement of volunteer teams and social support.Based on these findings,a flowchart illustrating the family decision-making process for the referral of terminal patients was constructed.Conclusions The study provides a comprehensive analysis of various factors influencing family decision-making in the referral of terminal patients in tertiary hospitals.The results underscore the significance of internal and external factors,emphasizing the integrated impact of decision patterns,family support,medical team support,referral channel conditions,and the involvement of volunteer teams and social support.The research offers profound insights into improving the referral process for terminal patients and enhancing the quality of family decision-making.It provides valuable recommendations for future improvements in medical services and decision support.

关 键 词：终末期患者 转诊决策 家庭支持 家庭决策 

分 类 号：R47[医药卫生—护理学] R48[医药卫生—临床医学]