晚期肿瘤患儿家属临终关怀认知调查及相关因素分析

Analysis of cognition of hospice care and related factors in the family of children with advanced cancer

目的探讨晚期肿瘤患儿家属临终关怀认知调查现状及相关影响因素。方法2015年1月～2016年12月应用自行设计的《晚期肿瘤患儿临终关怀认知行为量表》对120例晚期肿瘤患儿家属进行调查，了解晚期肿瘤患儿家属临终关怀相关知识情况及影响因素，并给予患儿家属针对性护理干预，以提高患儿家属临终关怀认知，改善晚期肿瘤患儿家属心理状况。结果120例晚期肿瘤患儿家属对临终关怀知晓率为54．17％，不知晓率为45．83％。经单因素分析可知，影响晚期肿瘤患儿家属l临终关怀认知的因素包括家属年龄、文化程度、居住地、接受临终关怀指导、独生子女和经济水平。经Logistic多因素分析可知，家属年龄〉40岁、学历初中或以下、来自农村是影响恶性肿瘤患儿家属临终关怀知晓率的独立危险因素，而接受临终关怀指导是恶性肿瘤患儿家属临终关怀知晓率的保护因素。患儿家属经临终关怀护理干预后SAS、SDS评分均明显低于干预前，差异有统计学意义（均P〈0．05）。结论年龄、学历、居住地是影响晚期肿瘤患儿家属临终关怀认知率的独立危险因素，而接受过临终关怀指导的家属临终关怀认知率较高。医护人员应对临终关怀认知率低的晚期肿瘤患儿家属加强宣传教育工作，尤其对于学历低、年龄大、来自农村的家属加强临终知识宣教，改善患儿家属焦虑、抑郁的心理症状。

Objective To explore the present situation of cognition of hospice care and related factors in the family of children with advanced cancer. Methods A total of 120 cases of families with advanced cancer were investigated with by self-designed ＂ Hospice Care Behavior Scale for Children with Advanced Tumor＂ to understand the clinical care of children with advanced cancer and influencing factors were analyzed from January 2015 to December 2016. In addition, targeted nursing intervention was given to the families of the children, so as to improve the cognition of hos- pice care and improve the psychological status of family members of children with advanced tumors. Results The ter- minal care awareness rate of 120 advanced tumor paediatric patients＂ family members was 54. 17% , and non-awareness rate was 45.83%. It was known through single factor analysis that the factors influencing the terminal care awareness of advanced tumor family members included age, education background, region, accepting terminal care guidance, only child and economic. It could be seen from Logistic multlple-factor analysis that those family members less than or equal to 40 years old, education background was junior high school or below and were from village were the independent risk factors which influenced the terminal awareness rate of malignant tumor paediatric patients＂ family members. However, accepting terminal care guidance was the protective factor of malignant tumor paediatric patients＂ family members. After conducting terminal care nursing to the paediatric patients＂ family, SAS and SDS were inferior to it before intervention after the intervention of family, of which the differences had statistical significance （P 〈0. 05 ） . Conclusion Age, educational background and rural area are the independent risk factors for the hospice care of children with advanced cancer, and the hospices of hospice care guidance are higher. The medical staff should strengthen the promotion of edu- cation to the families of children with advanced cancer who have low awareness of end-of-life care. In particular, the family members with low educational background, old age and rural families should strengthen the education of the dying knowledge, and improve the psychological symptoms of anxiety and depression among the families of the children.