运用德尔菲法构建晚期癌症患者“医院-社区”安宁疗护模式的研究  

Construction of a hospice care model for late-stage cancer patients in the hospital-community setting using the Delphi method

作　　者：何秀雯 张梦歌 杨一龙 HE Xiuwen;ZHANG Mengge;YANG Yilong(School of Public Health,Hangzhou Normal University,Hangzhou,Zhejiang 311121,China)

机构地区：[1]杭州师范大学公共卫生学院,浙江杭州311121

出　　处：《中国农村卫生事业管理》2024年第10期709-716,共8页Chinese Rural Health Service Administration

基　　金：国家自然科学基金项目(72004232);浙江省医药科技计划项目(2024KY243);杭州师范大学科研启动经费项目(KYQD-2023-154)。

摘　　要：目的基于出院计划模式制定晚期癌症患者“医院-社区”联动的安宁疗护模式,为跨机构安宁疗护发展提供参考意见和建议。方法2023年8月—10月,结合文献检索和半结构化访谈结果构建初始指标体系,应用德尔菲法对11名专家进行两轮专家咨询,从重要性和可行性两个维度进行1~5级指标评价。结果经过两轮专家咨询方法,两轮问卷回收率均100%,专家判断系数为0.95,专家熟悉程度为0.89。最终构建指标体系包含7个一级指标(延续性安宁疗护的目的等)、28个二级指标(整体性、延续性等)、59个三级指标(舒缓压力、灵性关怀、家庭支持)。第一轮专家咨询2个一级指标的肯德尔系数分别为0.068和0.098;第二轮专家咨询2个一级指标的肯德尔系数分别为0.103和0.125。结论该研究构建的安宁疗护模式内容全面、科学可靠,制定晚期癌症患者“医院-社区”联动安宁疗护模式有助于解决安宁疗护中医院社区功能定位不清、缺失延续性等问题。Objective To develop a hospice care model for late-stage cancer patients through hospital-community collaboration based on the discharge planning model,providing insights and recommendations for the development of cross-institutional hospice care.Methods From August to October 2023,an initial indicator system was constructed based on literature review and semi-structured interviews.The Delphi method was employed with 11 experts in two rounds of consultation to evaluate the indicators on a scale of 1 to 5 for importance and feasibility.Results Through two rounds of expert consultation,with a 100%response rate for both rounds,the expert judgment coefficient was 0.95,and the expert familiarity coefficient was 0.89.The final indicator system consisted of 7 primary indicators(e.g.,purpose of continuity of hospice care),28 secondary indicators(e.g.,comprehensiveness,continuity),and 59 tertiary indicators(e.g.,stress relief,spiritual care,family support).Kendall's coefficients for two primary indicators in the first round of expert consultation were 0.068 and 0.098,while in the second round,they were 0.103 and 0.125.Conclusion The hospice care model constructed in this study is comprehensive and scientifically reliable.Developing a hospital-community collaborative hospice care model for late-stage cancer patients can help address issues such as unclear hospital-community functional positioning and lack of continuity in hospice care.

关 键 词：安宁疗护 出院计划模式 晚期癌症患者 “医院—社区”联动 德尔菲法 信息化建设 

分 类 号：R197[医药卫生—卫生事业管理]