医护人员对预立医疗照护计划认识与实践的质性研究

The perspectives and practice status quo of Advance Care Planning among medical professionals

目的:深入了解医护人员对预立医疗照护计划(AdvancedCare Planning,ACP)的认识与实践情况,为推动ACP在我国临床有效开展提供依据。方法:采用现象学研究方法,于2021年9月—11月在北京市2家三级甲等医院、1家社区卫生服务中心和1家临终关怀医院,对11名医护人员进行半结构式访谈,使用Colaizzi 7步分析法分析提炼出主题。结果:从访谈资料中凝练出4个主题及9个亚主题。4个主题包括:(1)ACP目前在我国尚属起步阶段,临床实践处于尝试探索阶段;(2)医护人员对ACP概念认识不足,对ACP实践意义持肯定态度;(3)谈话契机、医护人员能力是开展ACP实践的关键;(4)传统文化观念、医疗成本不足及政策不到位是ACP实践的阻碍因素。结论:需要重视医护人员对ACP的认知与实践能力,针对工作中发现的问题与困境,进一步探索具有文化适用性的实践策略,以推进医护人员开展ACP。

Objective:To explore the perspectives and practice status quo of Advance Care Planning(ACP)among medical professionals.Methods:The phenomenological research method was used.Semi-structured interviews were conducted with 11 medical staff in two tertiary hospitals,a community health service center and a hospice hospital in Beijing from September to November 2021.Data were analyzed by using Colaizzi’s 7-step analysis method.Results:There are 4 themes and 9 sub-themes emerged from the interview data.The four themes were:(1)ACP is still in its infancy in China,and clinical practice is still in the trial stage;(2)medical professionals do not have enough knowledge of the ACP concept,but hold a positive attitude towards the significance of ACP;(3)the communication time,ability of medical professionals and the actual situation of patients are the keys to ACP practice;(4)traditional cultural concepts,inadequate medical investment and policy are the barriers to the current practice of ACP.Conclusion:It is necessary to pay attention to the perspectives and practical ability of ACP among medical professionals.We should further explore culturally appropriate ACP practice strategies based on the problems and dilemmas found in this study,so as to promote the implementation of ACP by medical professionals in the future.