晚期癌症患者预立医疗照护计划接受现状及影响因素分析

Statue quo and influencing factors of advance care plan acceptance in advanced cancer patients

目的探讨晚期癌症患者中接受预立医疗照护计划(ACP)现状,并调查影响其接受ACP的影响因素。方法选择2019年8月—2020年8月在医院住院的晚期癌症患者120例作为研究对象,应用一般资料调查问卷收集患者基础信息和临床资料,采用ACP接受程度调查问卷(APCQ)调查患者对ACP实施接受的现状,按照APCQ评分将其分为对照组和接受组,APCQ≤57分为对照组,APCQ>57分为接受组。采用单因素分析和多因素Logistic回归模型,分析影响晚期癌症患者接受ACP的影响因素。结果晚期癌症患者ACP接受度总分为41.19±4.30分,其中态度、感受、打算等各维度评分分别为9.07±1.01分、25.01±2.12分、7.11±1.17分,120例患者中,63例患者愿意接受ACP沟通,占52.5%。经单因素筛选,多因素Logistic回归分析结果显示,文化程度、宗教信仰、对死亡态度及医患关系等均是影响晚期癌症患者接受ACP的影响因素(P<0.05)。结论晚期癌症患者对预立医疗照护计划接受程度较低,其中文化程度低、有宗教信仰、对死亡恐惧及医患关系紧张是造成晚期癌症患者接受程度低下的因素。临床应提高对上述因素的重视,完善对患者照护,强化关于ACP的科普力度,加强沟通,减少影响因素同时,提高晚期癌症患者对ACP的接受程度。

Objective To investigate the status quo of advance care planning(ACP)in patients with advanced cancer,and to investigate the influencing factors of ACP.Methods 120 patients with advanced cancer admitted in the hospital from August 2019 to August 2020 were selected as the research objects.The general information questionnaire was used to collect the basic information and clinical data of patients,and the ACP Acceptance Questionnaire(APCQ)was used to investigate the current situation of patients’acceptance of ACP.They were divided into control group and acceptance group according to APCQ score.APCQ≤57 points was divided into the control group and APCQ>57 points was divided into the acceptance group.Univariate analysis and multivariate Logistic regression model were used to analyze the influencing factors of ACP in advanced cancer patients.Results The total score of ACP acceptance in advanced cancer patients was 41.19±4.30 points,and the scores of attitude,feeling,intention and other dimensions were 9.07±1.01 points,25.01±2.12 points,7.11±1.17points,respectively.Among 120 patients,63 patients were willing to accept ACP communication,accounted for 52.5%.After univariate screening,the results of multivariate Logistic regression analysis showed that education level,religious belief,attitude toward death and doctor-patient relationship were the influencing factors of ACP acceptance in advanced cancer patients(P<0.05).Conclusion Advanced cancer patients have low acceptance of advance medical care plan,among which low education level,religious belief,fear of death and tension between doctors and patients are the factors that cause low acceptance of advanced cancer patients.Clinical attention should be paid on the above factors,patients’care should be improved,science popularization on ACP should be strengthened,communication should be strengthened,the influencing factors should be reduced,and the acceptance of ACP in patients with advanced cancer should be improved.