基于供需方调研的居家安宁疗护服务预立医疗照护计划的影响因素及决策流程优化对策  

Influencing factors of advance care planning of home hospice care service based on supply-demand survey and optimization countermeasures of decision-making process

作　　者：夏卿 龚雯静 XIA Qing;GONG Wenjing(Department of Traditional Chinese Medicine,Caoyang Community Health Service Center,Putuo District,Shanghai 200062,China)

机构地区：[1]上海市普陀区曹杨街道社区卫生服务中心中医科,上海200062

出　　处：《医药前沿》2025年第12期84-87,共4页Journal of Frontiers of Medicine

基　　金：上海市安宁疗护科研能力提升项目(2023ANLH17)。

摘　　要：目的开展服务供方需方调查研究,分析影响终末期晚期肿瘤患者居家安宁疗护服务预立医疗照护计划(ACP)的影响因素及决策流程优化对策。方法选取2023年9月—2024年8月上海市普陀区曹杨街道辖区的126例终末期晚期肿瘤患者及其主要照护者作为服务需方,同时选取上海市普陀区各公立医疗机构开展安宁疗护服务的80名医护人员作为服务供方,采用问卷法进行调查研究,分别发放需方问卷和供方问卷,回收有效问卷后进行相关统计分析。结果需方回收有效问卷126份,供方回收有效问卷80份。供方ACP知晓率及预立医疗照护计划接受程度调查问卷(ACPQ-C)总分高于需方(P<0.05);线性回归分析结果显示,接受ACP程度是影响需方ACPQ-C总分的影响因素(P<0.05);是否知晓、接受ACP程度是供方ACPQ-C总分的影响因素(P<0.05)。结论安宁疗护服务的供需方对于ACP总体接受程度较高,ACP融入终末期晚期肿瘤患者安宁疗护服务流程重点工作在于缩小患者、家属和医疗服务方对治疗决策的认知差异,并加强对服务供方的培训,提高其实施ACP的能力,从而全面提升安宁疗护服务效能。Objective To investigate the service supplier and demander,and analyze the influencing factors and optimization strategies of decision process of advance care planning(ACP)of home hospice care for terminal cancer patients.Methods From September 2023 to August 2024,a total of 126 end-stage tumor patients and their main caregivers in Caoyang Street,Putuo District,Shanghai were selected as service demander,at the same time,80 medical staff who carried out hospice care services in public medical institutions in Putuo District,Shanghai were selected as service supplier,questionnaires were used to investigate and study,and questionnaires were issued respectively on the demander and supplier,relevant statistical analysis was carried out after collecting valid questionnaires.Results A total of 126 valid questionnaires were collected by the demander and 80 valid questionnaires were collected by the supplier.The ACP awareness rate and the total score of Patient's Advance Care Planning Acceptance Questionnaire(ACPQ-C)of the supplier were higher than those of the demander(P<0.05);the results of linear regression model analysis showed that the degree of ACP acceptance was the factor of the total score of ACPQ-C of the demander(P<0.05);whether the supplier knew and accepted ACP was the influencing factor of the total score of ACPQ-C(P<0.05).Conclusions The supply and demand of hospice care services generally have a high degree of acceptance of ACP,the focus of integrating ACP into hospice care service process for endstage patients with advanced tumors is to narrow the cognitive differences between patients,their families and medical providers in treatment decisions,strengthen the training of service providers,and improve their ability to implement ACP,so as to comprehensively improve the effectiveness of hospice care services.

关 键 词：肿瘤 安宁疗护 预立医疗照护计划 问卷调查 认知差异 影响因素 策略 

分 类 号：R473[医药卫生—护理学]