以实践为导向构建社区医务人员安宁疗护服务能力评价工具及信效度研究

Construction of a Practical Oriented Tool for Evaluating the Ability of Community Medical Staff to Provide Hospice Care Services and Its Reliability and Validity

背景我国安宁疗护服务已进入深度实践时期,许多城市将基层医疗卫生服务机构作为开展安宁疗护的首要场所。社区安宁疗护服务主要为全科团队式服务,但目前尚缺乏切实统一的社区安宁疗护服务人员相关能力考核标准与要求。目的结合社区安宁疗护服务实践,编制社区卫生服务中心医务人员安宁疗护服务能力评价工具,并对其信效度进行研究。方法于2022年6月—2023年3月,通过文献回顾、质性访谈、两轮德尔菲专家咨询进行条目分析,形成安宁疗护服务能力评价工具;于2023-04-01—2023-05-12对上海市浦东新区1281名社区卫生服务中心医务人员开展一般资料、对安宁疗护服务的认知和经历、安宁疗护服务能力评价工具和人文关怀能力量表的问卷调查,检验安宁疗护服务能力评价工具的信度、效度,并采用多元线性回归分析探讨安宁疗护服务能力的影响因素。结果通过文献检索分析和质性访谈形成49个初始条目。德尔菲专家咨询法共邀请上海市15名研究和开展安宁疗护服务的权威专家,其中专家权威系数为0.87,整体指标体系的Kendall和谐系数为0.624(P<0.01),经过两轮德尔菲专家咨询,最终形成具有50个条目的评价工具。问卷调查部分共发放1300份问卷,回收1284份,问卷回收率为98.77%(1284/1300)。安宁疗护服务能力评价工具标准化后的Cronbach'sα系数为0.993,Spearman-Brown折半信度为0.935,总体信度较好。效度检验显示,KMO值为0.987,Bartlett's球形检验值为119119.104,P<0.001,表明该量表效度良好,且适合因子分析。因子分析显示,所有条目的因子载荷系数≥0.4,共同度>0.2,因此保留50个条目。抽取4个公因子,累积方差贡献率为86.517%。相关分析显示,本次构建的安宁疗护服务能力评价工具的总得分和人文关怀量表总分呈显著正相关关系(r=0.819,P<0.001),说明该评价工具具有良好的校标关联效度。多元线性回归分析结果显示,性别、学历、从事社区工作年限、是否经历亲属离世、是否经历安宁疗护培训、安宁疗护服务工作时长、是否愿意从事安宁疗护服务工作是安宁疗护服务能力的影响因素(P<0.05)。结论本研究构建的社区卫生服务中心医务人员安宁疗护服务能力评价工具有较好的科学性和可靠性,信效度较好,可用于评价社区医务人员在安宁疗护服务中的各项能力。

Background Hospice care service has been practiced deeply in our country.Many cities have taken primary medical and health institutions as the prime places to carry out hospice care,such as in Shanghai.The main community hospice care service are provided by the teams which are composed of general practitioners and nursing staff.Meanwhile,there is still a lack of unified assessment standards and requirements for the abilities of community medical staff.Objective Based on the actual situation hospice care service,this study compilies an evaluation tool for the hospice care service ability of medical staff in community health service centers and conducts a research of the reliability and validity.Methods From June 2022 to March 2023,through literature review,qualitative interview and two rounds of Delphi expert consultation,the project was tested by a questionnaire and analyzed.1281 medical staff of community health service centers in Pudong New Area,Shanghai,China,were surveyed from 2023-04-01 to 2023-05-12.A questionnaire survey which was covering general information,knowledge and experience of hospice service.Hospice service competence evaluation tool and humanistic care competence scale were conducted to test the reliability and validity of the hospice service,and a multiple linear regression analysis was used to explore the influencing factors of hospice service competence.Results Through literature search analysis and qualitative interviews with experts,49 initial entries were formed.The Delphi expert consultation method invited a total of 15 authoritative experts in Shanghai who study and carry out hospice services,in which the expert authority coefficient was 0.87,and the Kendall harmony coefficient of the overall index system was 0.624(P<0.01),and the evaluation tools for the 50 entries were finally formed after two rounds of Delphi expert consultation.A total of 1300 questionnaires were distributed in the questionnaire survey part,and 1284 questionnaires were recovered,the effective recovery rate of the questionnaires was 98.77%(1284/1300).The reliability coefficient of standardized evaluation tools was 0.993 with Cronbach'sαcoefficient.The data of Spearman-Brown's broken half reliability was 0.935,that means the overall reliability coefficient is good.Besides,KMO value was 0.987,Bartlett spherical value was 119119.104,P<0.001,indicating that the scale had a good validity and was suitable for factor analysis.Factor analysis showed that the factor loading of all items was≥0.4 and the commonality was>0.2,so all 50 items were retained.Four common factors were selected,and the cumulative variance contribution rate was 86.517%.Correlation analysis showed that there was a significant positive correlation between the total score of the hospice care service ability evaluation tool constructed in this study and the total score of the humanistic care scale(r=0.819,P<0.001),indicating that the evaluation tool had a good calibration correlation validity.The results of multiple linear regression analysis showed that:gender,education,years of working in the community,whether or not they experienced the death of a relative,whether or not they experienced hospice training,the length of hospice service work,and whether or not they were willing to engage in hospice service were the influencing factors of hospice service competence(P<0.05).Conclusion In this study,it proofs that the questionnaire tool for evaluating the ability of community health service center medical staff is scientific,reliability,and validity,and can be used to evaluate the various abilities of community general practitioners in hospice care services.