肝移植受者手术决策困境的质性研究

Surgical decision-making dilemmas among liver transplant recipients:a qualitative study

目的探索肝移植受者手术决策过程中面临的困境,为促进医患共同参与肝移植手术决策提供参考。方法采用目的抽样法选取15例行肝移植术的受者进行深入访谈,采用Colaizzi七步法分析访谈资料。结果肝移植受者手术决策困境包括3个主题:决策情境特殊,受者参与决策机会受限;决策内容复杂,受者参与决策过程艰难;决策主体消极,参与决策意愿及能力不足(健康信念缺乏;自我负担感沉重,过度依赖他人;手术决策相关信息缺乏)。结论肝移植受者手术决策过程中受到决策情境、决策内容及决策主体多方面因素共同影响。护士应指导肝移植受者及家属加强症状管理、辅导其参与共同决策并协助其提升健康素养,以保障受者临床决策参与权。

Objective To explore the dilemmas faced by liver transplant recipients in the surgical decision-making process,so as to provide references for promotingshared decision-making.Methods Purpose sampling method was used to select 15 liver transplant recipients for in-depth interviews,and the interview data were analyzed utilizing the Colaizzi seven-step method.Results The surgical decision-making dilemmasamong liver transplant recipients were consisted of three themes:the decision-making context was special,and the recipients'opportunities participating in decisionwere limited;the content of decisionwas complicated,and the process for the recipients participating in decisionwas difficult;the decision-maker was negative,and their willingness and ability participating in decision-making was insufficient(lack of health beliefs,self-perceived burden was heavy and over-reliance on others,lack of information related to surgical decision-making).Conclusion The surgical decision-making process among liver transplant recipients is affected by decision-making context,content and decision-maker,so clinical nurses should guide them and their families to strengthen symptom management,help them participate in shared decision-making and improve their health literacy,so as to guarantee the recipients'right to participate in clinical decision-making.