急诊老年衰弱患者预立医疗照护计划准备度现状及影响因素分析

Advance care planning readiness and influencing factors in emergencyy frail elderly patients

目的 描述上海某三级甲等医院急诊老年衰弱患者预立医疗照护计划(advance care planning,ACP)准备度现状,并探讨其影响因素。方法 采用预立医疗照护计划准备度量表、一般资料调查表、中文版FRAIL量表、社会支持评定量表作为调查工具对上海市某三级甲等医院急诊科157例急诊老年衰弱患者进行调查。采用多元线性逐步回归分析ACP准备度的影响因素。结果 157例急诊老年衰弱患者ACP准备度总分为(80.38±9.75)分,其中态度、信念、动机维度得分分别为(33.59±7.14)分、(19.34±3.42)分、(27.46±4.17)分。单因素分析中最高学历、医疗支付方式、患病时间、治疗意愿、社会支持、客观支持具有统计学意义。多因素分析显示,最高学历、患病时间、治疗意愿是急诊老年衰弱患者预立医疗照护计划准备度的影响因素(P<0.05)。结论 本组急诊老年衰弱患者预立医疗照护计划准备度总体处于中等偏上水平。医护人员应通过制订行之有效的干预策略,促进其表达终末期的护理需求。

Objective To describe the current status of advance care planning(ACP)readiness in emergency frail elderly patients in a tertiary class A hospital in Shanghai and to explore its influencing factors.Methods Advance Care Planning Readiness Scale,the General Information Questionnaire,the Chinese version of the FRAIL scale,and the Apprehension Social Support Scale were used as survey instruments to investigate 157 emergency geriatric frail patients in a tertiary class A hospital in Shanghai.Multiple linear stepwise regression was used to analyze the influencing factors of ACP readiness.Results The total ACP readiness score was(80.38±9.75)among 157 elderly frail patients,of which the scores of attitude,belief,and motivation dimensions were(33.59±7.14),(19.34±3.42),and(27.46±4.17),respectively.Highest education,health care payment method,duration of illness,willingness to treat,social support,and objective support were statistically significant in the univariate analysis.Multivariate analysis showed that highest education,duration of illness,and willingness to treat were factors influencing ACP readiness in elderly frail patients in the emergency setting(P<0.05).Conclusion Advance care planning readiness in the group of emergency frail elderly patients is generally moderate to high.Healthcare professionals should facilitate the expression of their end-stage care needs by developing proven intervention strategies.