终末期肿瘤患者的优逝现状及影响因素调查研究

Investigation on good death status of terminally ill cancer patients and the influence factor

目的基于护士的角度调查终末期肿瘤患者的优逝状况并探索其影响因素。方法采用问卷调查法,在患者离世后3个月内,对其主管护士进行横断面调查,从护士的角度评价终末期肿瘤患者的优逝现状。采用便利抽样法,选择2017年10月-2018年1月某医院离世的209例终末期肿瘤患者的主管护士101名,采用护士基本资料问卷、患者资料问卷、优逝调查问卷对护士进行调查。采用单因素分析、Pearson相关和多元线性回归分析终末期肿瘤患者优逝状况的影响因素。结果患者优逝水平得分为(243.00±39.21)分,其中独立性[(7.43±4.25)分]、身体和心理舒适[(8.17±4.82)分]、信仰和精神上的舒适[(8.53±4.72)分]3个因子的得分最低,被尊重[(18.32±2.76)分]、与医护人员保持良好关系[(18.23±2.59)分]、自然死亡[(17.97±3.42)分]3个因子的得分最高。患者所在科室、医疗付费方式、其主管护士是否接受专业培训经历、离世前3个月内接受治疗方式不同的患者优逝状况得分差异有统计学意义( t值分别为17.351、2.158、-2.679、-2.993;P<0.05);Pearson相关分析显示,护士的工作年限与终末期肿瘤患者优逝状况总分呈正相关( r=0.953, P<0.01)。回归分析发现,患者所在科室为肿瘤内科、治疗方式、护士接受专业培训经历是终末期肿瘤患者优逝状况的影响因素(P<0.05)。结论终末期肿瘤患者总体优逝状况较差,加强护士安宁疗护的知识和技能的系统培训,有助于提高肿瘤患者的终末期护理质量。

Objective To explore the good death status of terminally ill cancer patients from the nurses' perspective and identify associated factors. Methods A cross-sectional survey was conducted among the nurses in charge of the patients within 3 months after their death to evaluate the status quo of patients with end-stage cancer from the perspective of nurses, using anonymous questionnaire. Using convenient sampling method, 101 competent nurses from 209 patients with end-stage tumors who died in a hospital from October 2017 to January 2018 were selected. The nurses were investigated with nurses' general information questionnaire, patient information questionnaire and Good Death Inventory (GDI). Single factor analysis, Pearson correlation and multivariate linear regression analysis were used to analyze the influencing factors of good death in patients with end-stage cancer. Results The total score of GDI was (243.00±39.21). Among GDI, the three lowest scores were independence (7.43±4.25), physical and psychological comfort (8.17±4.82), and religious and spiritual comfort (8.53±4.72); while the three highest scores were being respected as an individual (18.32±2.76), good relationship with medical staff (18.23±2.59), and natural death (17.97±3.42). There were significant differences in patients' death status among different departments, medical payment methods, professional training experience of competent nurses and treatment methods within 3 months before death (t=17.351, 2.158, -2.679, -2.993; P<0.05). Pearson correlation analysis showed that nurse working life was positively correlated with the total score of GDI (r=0.953, P<0.01). Regression analysis showed that the factors influencing the good death of patients with end-stage cancer were the department of oncology medicine, the way of treatment and the professional training experience of nurses (P<0.05). Conclusions The overall status of good death of terminally ill cancer patients is poor. To strengthen the palliative care training about the knowledge and skills helps to improve the nursing quality of end-of-life care and achieve the goal of good death.