基于Q方法的老年头颈癌患者术前预立医疗照护计划决策态度探究  

A Study of preoperative advance care planning decision-making attitudes of elderly patients receiving head and neck cancer surgery based on Q methodology

作　　者：杨慧贤 徐晋霞[2] 徐晶 段睿睿 田艳芝 丁永霞[1] Yang Hui-xian;Xu Jinxia;Xu Jing;Duan Ruirui;Tian Yanzhi;Ding Yongxia(School of Nursing,Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学护理学院,山西太原030001 [2]山西省肿瘤医院手术室

出　　处：《护理学杂志》2024年第10期6-11,共6页Journal of Nursing Science

基　　金：山西省留学人员科技活动择优资助项目 (20230024)。

摘　　要：目的分析老年头颈癌患者对术前预立医疗照护计划决策态度,为老年头颈癌患者术前预立医疗照护计划干预模式的构建提供参考。方法对13例老年头颈癌患者进行半结构访谈,并在文献回顾基础上生成Q陈述,总结、整理后编号并随机排列以备用;另选取18例老年头颈癌患者按Q方法对Q陈述进行排序,对所得数据进行因子分析,以明确患者的决策态度。结果共提取3个因子,老年头颈癌患者对术前预立医疗照护计划的决策态度类型可分为3种,即共同决策型、专业决策型、自主决策型,3种类型患者均认为应在术前进行预立医疗照护计划讨论,均不认为手术前讨论此话题是不吉利或不孝的,3种类型间也存在一定差异。结论术前与老年头颈癌患者进行预立医疗照护计划讨论具有一定可行性,其参与术前预立医疗照护计划决策的态度各有不同,医务人员应甄别患者的不同决策类型,针对性制定术前预立医疗照护计划。Objective To analyze the attitudes of older patients receiving head and neck cancer surgery on decision making towards preoperative advance care planning(ACP),informing the development of preoperative ACP interventions for older patients with head and neck cancer.Methods Semi-structured interviews were conducted with 13 elderly patients undergoing head and neck can-cer surgery,and Q statements were generated based on the literature review,summarized,organized,numbered and randomly ranked for backup;another 18 elderly patients undergoing head and neck cancer surgery were selected to rank the Q statements according to the Q methodology,and the resulting data were subjected to a factor analysis in order to clarify the patients′attitude towards decision-making.Results A total of 3 factors were extracted.The types of decision-making attitudes of elderly head and neck cancer surgery patients toward preoperative ACP could be categorized into 3 types:shared decision-making,professional decision-making,and self decision-making.All 3 types of participants believed that preoperative ACP discussions should be conducted before surgery,and they were opposed to the idea that it was inauspicious or ungrateful to discuss this topic before surgery.There were also some differences among the 3 types.Conclusion It is feasible to conduct preoperative ACP discussions with elderly patients undergoing surgery for head and neck cancer,whose attitudes toward participation in preoperative ACP vary.The medical staff should screen patients for different types of decision-making and target preoperative ACP interventions.

关 键 词：头颈癌 老年患者 手术 预立医疗照护计划 安宁疗护 决策态度 Q方法 质性研究 

分 类 号：R473.73[医药卫生—护理学] R48[医药卫生—临床医学]