终末期患者与家属治疗决策一致性研究

Consistency on end-of-life decision-making in terminal-stage patients and their families

目的了解终末期患者和家属治疗决策意向的一致性。方法采用方便抽样法,抽取南充市2所三级甲等医院终末期患者及家属268对,应用自行设计的终末期治疗决策意愿调查表分别进行调查。结果终末期患者与家属在"患者参与制定治疗决策"、"以提高生活质量为目的的姑息治疗"决策一致性为69.03%、74.63%(Kappa值分别为0.529、0.530,均P<0.01);其余4项决策一致性为32.84%～47.39%(Kappa值为0.080～0.210;P<0.05,P<0.01)。结论终末期患者与家属治疗决策意向存在差异,家属的治疗决策无法完全体现患者真实意愿。

Objective To determine the consistency on end-of-life decision-making in terminal-stage patients and their families. Methods A total of 268 pairs of terminal-stage patients and their families were selected from 2 tertiary hospitals in Nanchong using convenience sampling and were asked to complete a self-designed questionnaire regarding end-of-life decision-making intentions separately. Results The consistency on "patient participation in making treatment decision" and "palliative treatment for improving quality of life" was 69.03% and 74.63% respectively, with Kappa values being 0.529 and 0.530(P<0.01 for both). The consistency on the rest 4 decisions ranged from 32.84% to 47.39%, with the Kappa values being 0.080-0.210(P<0.05, P<0.01). Conclusion There is a difference in treatment decisions between terminal-stage patients and their families. Treatment decisions made by family members cannot fully reflect desire of patients.