癌症晚期患者临终意愿依从性评估体系的构建

Development of evaluation index system of the compliance of end-of-life care for terminal cancer patients

目的构建癌症晚期患者临终意愿依从性评估体系,为癌症晚期患者临终意愿依从性评估及干预提供参考。方法通过文献回顾及质性访谈(纳入9例患者、10名家属和15名医护人员)构建癌症晚期患者临终意愿依从性评估体系的初稿,并对17名专家进行2轮函询和层次分析法确定各指标的权重。结果第1、2轮的专家积极系数分别为88.2%和100.0%,专家权威系数分别为0.943和0.973,肯德尔协调系数分别为0.168~0.256和0.108~0.267,最终形成涵盖4个一级指标(医疗卫生条件、医护准备度、家庭支持和患者自身疾病因素)、29个二级指标、97个三级指标的癌症晚期患者临终意愿依从性评估体系。结论癌症晚期患者临终意愿依从性评估体系具有较高的科学性和可靠性,可为癌症晚期患者临终依从性水平评估和干预提供参考。

Objective To establish an evaluation index system for the compliance of end-of-life care preferences for terminal cancer patients,and to provide a reference for assessing and improving the compliance of end-of-life care preferences among terminal cancer patients.Methods Through literature review and qualitative interviews(involving 9 patients,10 family members,and 15 medical staffers),the first draft of the evaluation index system for the compliance of end-of-life care preferences for terminal cancer patients was constructed.Two rounds of consultation with 17 experts were conducted,and analytic hierarchy process(AHP)was used to determine the weight of each index.Results In the first and second rounds of expert consultation,the expert response rate were 88.2%and 100.0%,respectively;the expert authority coefficients were 0.943 and 0.973,respectively;the Kendall concordance coefficients were 0.168-0.256 and 0.108-0.267 for first-,second-and third-level indicators,respectively.Finally,an evaluation index system for the compliance of end-of-life care preferences for terminal cancer patients was constructed,including 4 first-level indexes(healthcare conditions,healthcare workers′readiness for care,family support,and disease-related factors),29 second-level indexes,and 97 third-level indexes.Conclusion The evaluation index system for the compliance of end-of-life care preferences for terminal cancer patients is scientific and reliable,which can provide a reference direction for the evaluation and intervention of end-of-life compliance in patients with terminal cancer.