安宁疗护病房在北京市运营现状的定性研究

Operational Status of Hospice Care Wards in Beijing:a Qualitative Study Using Semi-structured Face-to-face Interviews with Relevant Medical Professionals

目的安宁疗护在北京市起步不久,本研究通过对相关医院的医务人员进行访谈,了解北京市安宁疗护病房的运营情况以及面临的困难,为今后安宁疗护的发展提供对策和建议。方法于2017年7月,采用方便抽样方法,选取北京市3家设有安宁疗护病房的医疗服务机构的5名医务人员进行面对面、半结构访谈,访谈内容主要为安宁疗护的相关信息。对访谈资料进行编码、归类、精简并总结出主题。结果目前北京市各医院安宁疗护病房无统一的准入标准,患者以肿瘤晚期为主;患者选择安宁疗护时存在多种决策方式,医务人员会尽量让患者知情;安宁疗护给予缓解症状的治疗,放弃抢救生命的治疗;相关医疗报销无特殊项目,病房的床位供不应求;建设安宁疗护需要更多的投入,教育应是推广的着力点;社区与三级医院互为补充,转诊制度也应在安宁疗护中积极开展。结论在北京市发展安宁疗护,需要得到资金和政策的支持,维持安宁疗护病房的良性运营。制定合理的患者准入标准,促进安宁疗护规范发展。并且要重视教育在安宁疗护发展中的作用,包括对一般人群的早期死亡教育,以及专业人才在医学院校的培养。同时应充分发挥三级医院和社区医院各自在安宁疗护中的优势,将转诊制度落实到安宁疗护中。

Objective Hospice care is at a preliminary stage in Beijing.In order to understand the operational status(including the barriers encountered)of hospice care wards in Beijing,we interviewed relevant medical professionals,which may provide some countermeasures for the development of hospice care.Methods In July 2017,we conducted semi-structured face-to-face interviews about hospice care in a convenience sample of five medical professionals from three medical institutions in Beijing setting up wards and delivering hospice care for those in need.The interview data were coded,classified,briefed,and the themes were summarized.Results There were no unified criteria for patients being admitted to a hospice care ward.The admitted patients were mainly with advanced cancer.Care options were chosen by many types of decision-making methods.Medical professionals would try to persuade the patient's family members to make the patient aware of his own conditions.Hospice care was given for comfort rather than extending life.The national medical insurance scheme provides normal but not specially favorable reimbursement for the treatment.The beds were in short supply.The development of hospice care needs more investment,and related education activities should be taken.The community and tertiary hospitals play different but complementary roles in delivering hospice care,so the referral system for such patients should be developed vigorously.Conclusion The development of hospice care including the maintaining the normal operating status of hospice care wards in Beijing requires financial and policy supports.Moreover,unified admission criteria should be established for promoting the normative development of hospice care,death education and other relative educational activities for general populations should be valued and implemented as early as possible,professional talents should be fostered in medical colleges with great efforts,tertiary and community hospitals should be given full play in delivering hospice care,and the referral system for such patients should be implemented actively.