肿瘤医院医护人员对预立医疗照护计划态度与行为意向的调查分析

Investigation and analysis on the attitude and behaviour intention of medical staff in cancer hospital to advance care planning

目的本研究以调查浙江省某肿瘤专科医院医护人员对预立医疗照护计划(advance care planning,ACP)的态度及其行为意向,为姑息照护领域开展相关工作提供参考。方法采用随机抽样法,在2019年8-11月以浙江省某肿瘤专科医院的520名医护人员为调查对象,采用一般资料调查表、医务人员预立医疗照护计划态度与行为意向调查问卷进行调查研究。结果有99.8%的医护人员认为了解患者的生命意愿非常重要,有98.5%的医护人员认为医疗决策应是患者、家属及医生共同讨论后制定,且96.3%的医护人员赞同家属应该参与其中。肿瘤医院医护人员对ACP行为参与率为26.6%,在协助患者预先设立生命意愿意向方面,78.5%愿意、6.0%不清楚、15.6%不愿意。肿瘤医院医护人员实施ACP态度和行为意向影响单因素分析显示,不同工作年限.婚姻、文化程度、丧亲经历、对预先设立医疗照护计划认知的医护人员对ACP的态度及行为得分差异有统计学意义(均P<0.05)。多因素分析调查发现已婚、高学历、有丧亲经历、认知预先设立医疗照护计划影响肿瘤医院医护人员实施ACP的态度和行为意向。结论医护人员对晚期癌症患者实施ACP的态度及行为意向总体呈现较为积极的接纳态度,医护人员推行ACP的态度会受学历及婚姻状况等影响。在患者治疗上医护人员存在一些分歧,更倾向于ACP的实施,也更愿意帮助患者签署生命意愿。

Objective To investigate the attitudes and behavioural intentions of medical staff in a specialised cancer hospital in Zhejiang Province towards advance care planning(ACP)in order to provide reference for the relevant work in the field of palliative care.Methods A random sampling method was used to investigate 520 medical staff in a specialised cancer hospital in Zhejiang Province from August to November 2019.The general data questionnaire and the pre-established medical care plan attitude and behavioural intention questionnaire were used to conduct the investigation and study.Results Approximately 99.8%of the medical staff believed that it is very important to understand the patient's life intention;98.5%believed that medical decisions should be made after discussion amongst the patient,family members and doctors;and 96.3%agreed that family members should be involved.The participation rate of ACP behaviour of medical staff in the cancer hospital was 26.6%.In terms of assisting patients to set up living will in advance,78.4%were willing,6.0%were not clear,and 15.6%were unwilling.Univariate analysis showed significant differences in working years,marriage,education level,bereavement experience and cognition of pre-set medical care plan on ACP attitude and behaviour amongst medical staff in the cancer hospital(P<0.05).Multivariate analysis found that married,high education,bereavement experience and cognition of pre-set medical care plan were factors influencing the attitude and behaviour intention of medical staff in the cancer hospital to implement ACP.Conclusion In general,medical staff showed positive acceptance of ACP attitudes and behavioural intentions towards patients with advanced cancer,and ACP attitudes amongst medical staff were affected by education and marital status.Some differences were observed in the treatment of patients amongst the medical staff who were more inclined to the implementation of ACP and more willing to help patients sign a living will.