文化因素对安宁疗护实践影响的质性研究

A qualitative study on the specificity of cultural factors in palliative care practice

目的深入了解国内传统文化对安宁疗护实践的影响。方法采用目的抽样法,于2021年9月—2022年7月在北京市3所三级甲等医院、2所社区卫生服务中心、1所临终关怀医院中选取8例疾病晚期患者、12名疾病晚期或去世患者家属,就疾病晚期治疗与照护过程进行一对一深入访谈,采用Colaizzi 7步分析法进行分析、归类和主题提取。结果分析得出4个主题及8个亚主题。①集体主义文化下的家庭共担对患者医疗沟通与决策有影响:家属是患者医疗决策的主导者;家庭内部结构及关系影响医疗沟通和决策。②孝亲文化下的道德与情感交融对患者生命救治有影响:面对患者疾病晚期治疗,家属不轻言放弃;面对患者生命维持治疗措施的选择,家属感到纠结和摇摆。③反向关怀观念下的家庭情感联结对患者表达个人需求有影响:患者不愿在疾病照护和丧事安排等方面给家属增加负担;患者从家庭利益和家庭责任的角度考虑治疗措施。④传统生死观对患者与家属沟通临终问题有影响:患者与家属间缺乏沟通临终问题的桥梁;患者与家属沟通临终问题时宜采取非正式和间接的方式。结论在安宁疗护实践中,国内文化是不容忽视的重要影响因素。医护人员需围绕患者及其家属的决策、患者与家庭的反向关怀和孝亲行为、家庭临终问题沟通等方面探索并提供适宜的、具有文化安全性的安宁疗护服务。

Objective To understand the influence of traditional culture on domestic palliative practice.Methods The purposive sampling method was adopted to select 8 terminally ill patients and 12 family members of terminally ill patients/death who were interviewed on the process of end-of-life treatments and care.The interview subjects were from 3 tertiary A hospitals,2 community health service centers and 1 palliative hospital in Beijing during September 2021 to July 2022.The interview data were analyzed,categorized and thematically extracted by Colaizzi 7-step analysis method.Results 4 themes and 8 sub-themes were analyzed.①The influence of family sharing on patients’medical communication and decision-making under collectivism culture:family members play a dominant role in patients’medical decision-making,and family structures and relationships influence medical decision-making and communication.②The integrated influence of moral and emotion on patients’treatments under the culture of filial piety:families do not give up on patients’treatments,and families feel entangled and hesitated on the choice of life-sustaining treatments for patients.③The influence of family emotional connection on patients’personal needs under the culture of reverse care:patients are unwilling to increase the burden of care and funeral arrangements for their families;patients consider the choice of treatments from the perspective of family interests and family responsibilities.④The influence of traditional views of life and death on the communication of end-of-life issues between patients and family members:the lack of communication on end-of-life issues between patients and family members;the interaction of end-of-life issues should be informally and indirectly discussed between patients and their families.Conclusion Chinese culture is an important issue that cannot be ignored in palliative care.Medical staff should explore and provide appropriate and cultural safe palliative care centering on the three-party decision-making of doctors and patients and their families,the reverse care and filial behavior between patients and families,the family interaction on end-of-life topics.