家属对癌症晚期患者终末期治疗与抢救决策的质性研究

Qualitative Analysis of Family Members' Decision Making on Treatment and Resuscitation of Terminal Stage Advanced Cancer Patients

目的了解社区临终关怀中家属对癌症晚期患者终末期治疗与抢救决策的现实与意愿,为社区有效开展临终关怀服务提供指引。方法 2013年4—9月,采用质性研究中的现象学研究方法,对12名癌症晚期患者的家属进行深入访谈,并用现象学分析法进行资料分析整理,提出主题。结果家属对癌症晚期患者终末期治疗和抢救决策涉及:临终期治疗与抢救方法、救治地点、救治决策意见的形成等。其中方法以姑息治疗为主,终末抢救以无创抢救为主,只有个别家属能做到放弃无效抢救;地点以医院为主,较少能够实施居家关怀;家属对癌症晚期患者临终期治疗与抢救决策占主导作用。结论家属对癌症晚期患者终末期治疗与抢救的决策理念距临终关怀的目标仍有较大差距,我国的临终关怀事业需要社会层面广泛的死亡教育宣传、普及和国家出台相关政策支持、引导,以及从事临终关怀的医务人员的适时引导。

Objective To understand the status of family members＇ decision making and willingness on treatment and resuscitation of terminal stage advanced cancer patients in community hospice,and provide guidance for effective delivery of hos-pice care in community. Methods Phenomenological methods of qualitative study were applied in the research. Family members of 12 patients with advanced cancer were interviewed in depth during April and September in 2013,data was compiled and ana-lyzed by phenomenological analysis and relevant themes were concluded. Results Family members＇ decision making on treatment and resuscitation of terminal stage advanced cancer patients involved：methods of treatment and resuscitation in terminal stage, location of treatment,formation of decisions on treatment,etc. Regarding the methods,palliative care was the main approach, non - invasive resuscitation was predominant in terminal stage,only individual family members could give up ineffective resuscita-tion. Hospital was predominant regarding the location,few family members could deliver care at home. Family members played the dominant role in decision making on treatment and resuscitation of terminal stage advanced cancer patients. Conclusion Large gap still exists between family members＇ philosophy of decision making on treatment and resuscitation of terminal stage advanced cancer patients and the target of end of life care. Universal end of life care education and publicity at the social level,policy sup-port and guidance from the government,proper instructions from hospice health professionals are essential for the development of hospice care.