癌症晚期患者及家属对预前指示态度的一致性研究

Consistency in attitudes towards advance directive between advanced cancer patients and their family members

目的调查并分析癌症晚期患者及家属对预前指示及预前指示所含的生命维持治疗、死亡地点、诊断告知等态度的一致性。方法便利抽取北京市某三甲医院肿瘤科268对癌症晚期患者及家属,采用预前指示态度及终末生命意愿量表调查患者及家属对预前指示及生命维持治疗、死亡地点、诊断告知的态度。结果59.0%的患者愿意做预前指示,有88.4%的家属愿意遵守患者制定的预前指示意愿,患者及家属对预前指示态度的一致性系数Kappa值为0.010。患者及家属对生命维持治疗、死亡地点及诊断告知态度的Kappa值分别为0.158~0.235,0.227,0.056,一致性较差。结论癌症晚期患者及家属对预前指示态度一致性较差,家属对生命维持治疗、死亡地点、诊断告知的态度不能代表患者本人的意愿。临床医护人员应加强与患者及家属的沟通,提高患者及家属对预前指示态度的一致性。

Objective To explore and analyze consistency in attitudes towards advance directive regarding life-sustaining treatment,death place,and diagnosis informing,ect.,between advanced cancer patients and their family members.Methods Totally,268 pairs of advanced cancer patients and their family members were involved in the research through convenient sampling from oncology department of a 3A hospital in Beijing.Questionnaire of attitudes toward advance directive was used to measure consistency in attitudes towards advance directive between advanced cancer patients and their family members.Results Totally,59%of the cancer patients would like to make an advance directive,and 88.4%of the family members would like to follow patients′advance directive if they make one.The Kappa value for consistency in attitude towards advance directive between advanced cancer patients and their family members was 0.010.And the consistency in attitudes towards life-sustaining treatment,death place,and diagnosis informing were very low(Kappa values were 0.158-0.235,0.227,0.056 respectively).Conclusion Consistency in attitudes towards advance directive between advanced cancer patients and their family members was low.Family members′attitudes towards life-sustaining treatment,death place,and diagnosis informing can′t represent patients′own attitudes.Medical staff should strengthen communication with patients and family members,so as to promote their consistency in the attitudes towards advance directive.