青少年与年轻成人癌症患者预立医疗照护计划干预方案构建

Development of advance care planning intervention program for adolescent and young adult cancer patients

目的构建适用于我国青少年与年轻成人癌症患者的预立医疗照护计划干预方案,提高该人群预立医疗照护计划实践效果。方法基于跨理论模型,通过文献回顾、焦点小组访谈、半结构化访谈设计青少年与年轻成人癌症患者预立医疗照护计划干预方案,采用德尔菲法对15名专家进行专家函询。结果2轮函询问卷的有效回收率均为100%,专家权威系数为0.865;第2轮专家函询后,指标肯德尔和谐系数为0.238~0.394(均P<0.05)。最终形成的青少年与年轻成人癌症患者预立医疗照护计划干预方案包括前意向阶段、意向阶段、准备阶段、行动阶段、维持阶段,具体实施细则包括干预时机、干预主题、干预内容、干预目标、干预方式、评价指标。结论基于跨理论模型构建的青少年与年轻成人癌症患者预立医疗照护计划干预方案具有较好的专家认可度,但需进一步开展实证研究进行验证。

Objective To develop an advance care planning(ACP)intervention program for adolescent and young adult(AYA)can-cer patients in China,and to improve the effectiveness of ACP in this population.Methods Based on the transtheoretical model,the ACP intervention program for AYA cancer patients was developed through literature review,focus group interviews,and semi-structured interviews.Then,15 experts were consulted using the Delphi technique.Results All experts returned their questionnaires in the two-round consultation,with the authority coefficient of 0.865.The Kendall's coefficients of concordance were between 0.238 and 0.394 in round 2(all P<0.05).Final version of the ACP intervention program included five stages:precontemplation,contemplation,preparation,action,and maintenance.And specific implementation strategies were provided,including intervention timing,themes,contents,objectives,methods,and evaluation indicators.Conclusion The ACP intervention program for AYA cancer patients based on the transtheoretical model is well-accepted by experts.However,it remains to be validated in further stu-dies.