脑卒中患者接受预立医疗照护计划影响因素的质性研究

Qualitative Study on Factors Influencing the Acceptance of Advance Care Planning in Stroke Patients

目的了解脑卒中患者接受预立医疗照护计划(ACP)的影响因素,为在脑卒中患者中开展ACP提供参考。方法2022年12月至2023年6月,采用目的抽样方法,选取广西某三级甲等医院康复科收治的11例脑卒中患者作为研究对象。采用现象学研究方法,对其进行面对面半结构式深度访谈,运用Co-laizzi七步分析法对访谈资料进行分析。结果针对脑卒中患者接受ACP的影响因素共提炼出3个主题:行为态度消极(对ACP了解少、对ACP需求低);主观规范压力大(社会支持度欠佳、对ACP存在抵触心理);知觉行为控制困难多(对医务人员的信任度不一、客观因素不成熟)。结论脑卒中患者接受ACP的影响因素较多,医护人员应纠正患者对ACP的认知偏差,帮助其争取社会及家庭支持,同时加强ACP的客观支持,从而促进患者行为意向的转变,以提高其对ACP的接受水平。

Objective To investigate the factors influencing the acceptance of advance care planning(ACP)in stroke patients,aiming to provide a reference for promoting ACP in stroke patients.Methods From December 2022 to June 2023,11 stroke patients were selected by purposive sampling who were admitted to the Rehabilitation Department of a GradeⅢ-A hospital in Guangxi.They were investigated by face-to-face semistructured in-depth interviews using a phenomenological approach,and their interview data was analyzed using Colaizzi's seven-step analysis method.Results The following 3 themes were extracted regarding the factors influencing the acceptance of ACP in stroke patients:negative behavioral attitude(limited understanding of ACP and minimal demand for ACP);substantial pressure from subjective norms(weak social support and resistance to ACP);inadequate perceived behavioral control(varying degrees of trust in healthcare providers and immature objective factors).Conclusion There are many factors influencing the acceptance of ACP in stroke patients.Healthcare providers should adjust patients'misconceptions about ACP,help them to secure social and family support,and strengthen the objective support of ACP,aiming to change patients'behavior intention and improve their acceptance of ACP.