医护人员开展预立医疗照护计划影响因素质性研究的Meta整合

Meta-integration of qualitative research on the impact factors of advance care planning on medical staffs

目的 系统整合医护人员开展预立医疗照护计划(ACP)过程中的影响因素,为国内ACP的开展提供借鉴。方法 检索关于影响医护人员开展ACP因素的质性研究,数据库包括Web of Science、PubMed、The Cochrane Library、CINAHL、Medline、PsycINFO、Embase、中国知网、万方数据库、维普数据库、中国生物医学文献服务系统,检索时限自建库至2023年7月2日。文献质量评价使用澳大利亚乔安娜布里格斯研究所(JBI)质性研究质量评价标准,采用汇集性meta整合方法对文献进行归纳整合。结果 共纳入13篇文献,提取35个研究结果,归纳为12个类别,得到3个整合结果:(1)医护人员因素。包括知识和技能、态度和信念、情感劳动和时间、医护人员的ACP团队协作、与患者及家属的熟悉度。(2)患者及家属因素。包括患者病情、患者及家属的预后意识、患者和家属对ACP的认知和态度、家庭结构特征。(3)外部环境因素。包括组织支持、文化及宗教信仰、ACP讨论的空间环境。结论 预立医疗照护计划受医护人员、患者及家属、外部环境等因素的影响,建议未来对医护人员开展系统、专业的ACP培训,增强医护人员开展ACP的能力;提高患者及家属的ACP认知及准确的预后意识;完善ACP支持系统,以更好地克服开展ACP的外部阻碍。

Objective To systematically integrate the influencing factors in the process of advance care planning(ACP)carried out by medical staffs,and provide reference for the development of ACP in China.Methods The qualitative studies involving factors affecting the implementation of ACP by medical staffs were retrieved,and the databases including Web of Science,PubMed,The Cochrane Library,CINAHL,Medline,PsycINFO,Embase,CNKI,Wanfang,VIP,and CBM were searched,and the retrieve time was from the inception to July 2,2023.The quality of literature was evaluated by using the Joanna Briggs Institute(JBI)qualitative research quality evaluation standard,and the literatures were summarized by the aggregated meta-integration method.Results A total of 13 literatures were included,35 research results were extracted and summarized into 12 categories,and 3 integration results were obtained:(1)Factors of medical staff.These included knowledge and skills,attitude and belief,emotional labor and time,ACP teamwork collaboration of medical staffs,and familiarity with patients and their families;(2)Patient and family factors.These included patient's condition,prognostic awareness of patients and family members,ACP cognition and attitude of patients and family members,and family structure characteristics;(3)External environmental factors.There included organizational support,cultural and religious beliefs,and the spatial environment of ACP discussion.Conclusions Advance care planning is affected by medical staff,patients and their families,and external environment factors.It is suggested to strengthen the systematic and professional ACP training of medical staff in the future,enhance the ability of medical staff to carry out ACP,improve ACP cognition and accurate prognostic awareness of patients and their families,improve the ACP support system to better overcome the external barriers to ACP development.