安宁疗护病区患方共享决策中信息寻求态度的质性研究

Qualitative study on attitudes of advanced cancer patients and family caregivers towdards information seeking for shared decision making in palliative care department

目的了解晚期肿瘤患者及主要照护者在与医务人员进行共享决策时信息寻求的态度以及两者的差异,以期为临床实践者选取沟通方式提供参考。方法采用目的性抽样法选取入住安宁疗护病区的15例晚期肿瘤患者及12名主要照护者为研究对象。采用现象学研究方法进行半结构化深入访谈,运用Colaizzi七步分析法对资料进行分析,提炼主题。结果从患方共有态度的角度提炼出3个主题,即积极面对式信息寻求,趋利避害式信息寻求以及消极回避式信息寻求;从不同态度层面出发,提炼出3个主题,患者采取被动式信息寻求,主要照护者采取矛盾式信息寻求及屏蔽患者式信息寻求。结论针对患方信息寻求特点,医护人员应动态评估患方信息寻求态度,提供个性化信息支持,满足患方需求,推动共享决策实施。

Objective To deeply understand the attitudes of advanced cancer patients and family caregivers towards to information seeking when they take part in shared decision making with health professionals in palliative care department,to explore the diffe-rence between them,and to provide reference for clinical staffers to choose a better way of communication.Methods By purposeful sampling,15 patients admitted to the palliative care department for advanced cancer,and 12 family caregivers were selected.This qualitative study involved semi-structured face-to-face interviews of the participants,and Colaizzi′s analytical method was used to analyze the interview data and extract themes.Results From the perspective of attitudes in common held by the patients and family caregivers,three themes were extracted:proactive information seeking,seeking good news and avoiding harmful information,and evasive and negative information seeking.From the perspective of divisive attitudes held by the patients and family caregivers,three themes were extracted:patients fostered passive information seeking,family caregivers adopted ambivalent information seeking,and the latter also tried to seek information while shutting patients out.Conclusion In light of the features of information seeking by patients and their family,medical workers are obliged to make dynamic assessment of their attitudes towards information seeking,provide personalized information support,and satisfy their needs,in a bid to push forward implementation of shared decision-making.