晚期癌症患者预立医疗照护计划参与现状及影响因素研究

Status quo and influencing factors of advance care planning engagement among terminal cancer patients

目的了解晚期癌症患者预立医疗照护计划参与现状,分析影响因素,为针对性干预提供参考。方法采用一般资料调查表、中文版预立医疗照护计划参与问卷、家庭支持量表、创伤后成长量表对349例晚期癌症患者进行调查与分析。结果患者中文版预立医疗照护计划参与总分为84.54±23.05;处于行为改变前意识阶段、思考阶段、准备阶段、行动阶段的患者比例依次为36.7%、37.2%、22.3%及3.7%。回归分析显示,文化程度、病程、替别人做过医疗决定、家庭支持、创伤后成长是患者预立医疗照护计划参与的主要影响因素(均P<0.05)。结论晚期癌症患者预立医疗照护计划参与水平处于中等偏下,仅少部分患者处于行为改变准备与行动阶段;应加强文化程度低、病程短、家庭支持及创伤后成长水平较低患者的干预与支持。

Objective To explore the current status and determinants of advance care planning(ACP)engagement among terminal cancer patients,and to provide reference for targeted intervention.Methods A total of 349 terminal cancer patients were surveyed using a general information questionnaire,the Chinese version of the Advance Care Planning Engagement Survey(ACPES),the Family Support Scale(PSS-Fa),and the Post-Traumatic Growth Inventory(PTGI).Results The total score of ACP engagement was 84.54±23.05.Most patients were in the precontemplation and contemplation stage(36.7%and 37.2%respectively),22.3%were in the preparation stage and 3.7%were in the action stage.Regression analysis showed that,education level,course of di-sease,the experience of making medical decisions for others,family support,and post-traumatic growth were the main influencing factors of ACP engagement(all P<0.05).Conclusion The ACP engagement among terminal cancer patients is at low to moderate level and only minority of patients are at the preparation and action stages of change.Interventions and support should be targeted to those with low education level,short course of disease,poor family support and low post-traumatic growth.