老年人家属临终关怀决策的影响因素分析

Influencing Factors of Decision-making for Palliative Care in Family Members of Elderly People

目的探讨老年人家属对未来老年人临终关怀服务利用的决策意向及决策考虑的影响因素。方法采用一般资料调查表、老年人家属临终关怀决策意向和决策考虑问卷为工具,便利抽取995名老年人的家属进行横断面研究。结果927名家属(93.2%)表示如果老年人患上不可治愈疾病,同意让老年人接受临终关怀服务。统计分析结果显示女性、家中有医务人员、有照顾临终老年人经验、对临终关怀有了解的家属更倾向于为老年人选择临终关怀服务。此外,在老年人的意愿、年龄、生存状况、决策能力、疾病治愈的可能性、不同医疗方案优劣、预期寿命、医生给出的建议、服务具体内容、服务的实际效果、相关法律法规、家庭成员的意见和建议这些考虑因素方面,同意让老年人接受临终关怀的家属比拒绝组家属会更考虑这些因素。二元Logistic回归结果显示家属的性别、家中有无医务人员和医生的临终关怀建议是家属临终关怀决策意向的独立影响因素。结论老年人家属在决定老年人未来是否应用临终关怀服务方面持积极意向。老年人家属的临终关怀决策受性别、家中有无医务人员和医生的临终关怀建议的影响,这为临终关怀服务的规划和普及提供启示。

Objective To understand the intention,considerations and influencing factors for palliative care in family members of elderly people.Methods We conducted a cross-sectional study involving 995 family members of elderly people through convenience sampling method.They were surveyed by using a self-designed general information questionnaire and the Questionnaire of Intention and Considerations in Decision-making for Palliative Care in family members of elderly people.Results A total of 927 family members(93.2%)reported that they would accept palliative care service when elderly people suffer from incurable disease or condition.Statistical analysis showed that female family members,whether there were medial staff in the family,members with experience in caring elderly people at terminal stage,and those knowing palliative care were more likely to choose palliative care services.Influence factors of decision-making included the willingness,age,living status and decision-making ability,the possibility of cure for the disease,advantage or disadvantage of different health plans,prognosis of elderly people,doctor’s suggestions for palliative care,components of palliative care service,service effect,relevant laws and regulations and other family members’opinions and suggestions.Binary logistic regression analysis showed that the sex of family member,whether there were medial staff in the family or not and doctor’s suggestions for palliative care were independent factors influencing family members’intention for palliative care.Conclusion Family members show positive intention to accept palliative care for elderly people in the future.Decision-making for palliative care of family members is influenced by sex,whether there were medial staff in the family or not and doctor’s suggestion for palliative care,which provides implications for the construction of palliative care plan.