中国老年人安宁疗护服务利用问题研究

Research on the Utilization of Hospice and Palliative Care Services for the Elderly in China

“安宁疗护”是养老服务体系守护老年人“生命最后一公里”的重要环节。本文从临终老年人的安宁疗护服务需求出发,以“安宁疗护服务利用”为研究切入点,基于“生命质量理论、马斯洛需求层次理论和安德森健康卫生服务利用模型”构建分析框架,进而进行实证研究。研究发现:老年人的安宁疗护服务利用需求包括“身、心、社、灵”等多个方面,但需求层次存在明显的异质性;个体层面的使能因素和需求因素显著影响老年人的安宁疗护服务利用行为,服务利用效果则会受到服务利用行为与成本的影响。本文认为需要坚持“需求导向”的原则,从政策支持、服务供给、社会氛围和个体参与等多个维度着手,提升老年人安宁疗护服务利用的可及性、可获得性、可接受性和有效性。

Hospice and palliative care(HPC) is widely recognized as an important part of elderly services to protect "the last mile of life".This paper takes utilization of HPC services as the starting point and constructs an analytical framework based on "quality of life theory,Maslow’s hierarchy of needs theory,and Anderson’s model of health service utilization".The study finds that the needs of HPC among the elderly at the end of life include physical-related care needs,psychological-related support needs,society-related needs and spiritual needs,with dissimilarities among individuals.It also finds the enabling factors and needs factors significantly influence HPC utilization behaviors,and the effects of HPC utilization are influenced by different HPC utilization behaviors and costs.This study suggests that,in order to improve the accessibility,acceptability and effectiveness of the use of HPC services for the elderly,it is necessary to adhere to the principle of "needs-oriented" and take measures in terms of policy support,service delivery,social environment and individual participation.