医护人员对预先指示的态度及行为意向影响因素研究

doi:10.12114/j.issn.1007-9572.2020.00.527

摘要/Abstract

摘要： 背景　目前，公众对“尊严死”和终末期生命质量越来越关注，不再倾向于单纯延长生命长度，开始寻求预先指示的方法，医护人员作为参与预先指示的重要力量，其知晓率直接影响预先指示的推行效果。目的　了解医护人员对预先指示的认知状况及其影响因素，探讨推广的可行性及实践路径。方法　于2019年9—10月，采用分层抽样和简单随机抽样相结合的方法，从山东省抽取三级、二级医院及一级乡镇卫生院和社区卫生服务中心的540例医务人员为研究对象，并对其进行问卷调查。问卷内容包括一般人口学资料、个人经历部分、预先指示的态度及原因等。采用多因素Logistic回归分析影响医护人员预先指示态度及行为意向的因素。结果　共回收有效问卷530份（98.1%）。530例调查对象中，445例（84.0%）赞同指令型生前预嘱，赞同的首位原因为“尊重患者选择的权利”〔98.2%（437/445）〕；85例（16.0%）不赞同指令型生前预嘱，不赞同的首位原因为“不清楚生前预嘱是否符合法律规定”〔68.2%（58/85）〕。373例（70.4%）赞同代理型医疗决策，赞同的首位原因为“能反映患者意愿”〔84.5%（315/373）〕；157例（29.6%）不赞同代理型医疗决策，不赞同的首位原因为“患者拒绝继续治疗的意愿可能会被代理人改变”〔77.7%（122/157）〕。530例调查对象中，384例（72.4%）愿意协助患者制定预先指示，446例（84.2%）医护人员愿意把预先指示相关知识介绍给其他人，257例（48.5%）愿意马上签署生前预嘱。多因素Logistic回归分析结果显示，年龄、是否和患者讨论过预先指示和是否听说过预先指示是医护人员帮助患者制定预先指示意愿的影响因素（P<0.05）。结论　年龄、知晓状况是医护人员帮助患者制定预先指示意愿的影响因素；培训对预先指示意愿产生积极效能，应通过多种途径加强医护人员预先指示知识的培训。

关键词: 医护人员, 预先指示, 生前预嘱, 代理型医疗决策

Abstract: Background　Nowadays，increasing attention has been paid on "dignified death" and quality of life at the end of life. Instead of simply extending the length of life，hospice care patients with decision-making abilities begin to seek ways to make advance directives（AD）. As important participants in the process of making AD of patients，physicians and nurses' awareness of AD is directly associated with the promotion effect of AD. Objective　To explore the feasibility and practical path of promotion of AD by investigating the attitudes and behavioral intention concerning AD among physicians and nurses. Methods　From September to October 2019，stratified sampling and simple random sampling were adopted to select 540 medical workers from township hospitals and community health centers，and secondary and tertiary hospitals，Shandong Province. They received a questionnaire survey for collecting data regarding demographics，experience of encountering relatives' death and patients' death，attitudes towards AD and reasons，and so on. Multivariate Logistic regression was used to analyze the independent factors influencing their attitudes and behavioral intention concerning AD. Results　A total of 530（98.1%） valid questionnaires were collected. Among the 530 respondents，445（84.0%） agreed with the directive living wills，and the first reason was "Respecting the patient's right of choice"〔98.2%（437/445）〕，while 85（16.0%） disagreed with such living wills，with the first reason for disapproval being "Do not know whether making directive living wills is legal"〔68.2%（58/85）〕. 373（70.4%） agreed with surrogate medical decision-making，and the first reason was "It can reflect the patient's will"〔84.4%（315/373）〕，but 157（16.0%） disagreed with that，and the first reason was "the patient's refusal to continue treatment may be subject to change by proxy"〔77.7%（122/157）〕. 384（72.4%） were willing to assist patients in making AD，446（84.1%） were delighted to introduce AD-related knowledge to others，and 257（48.5%） were happy to sign a living will immediately. Logistic regression analysis revealed that physicians and nurses' willingness to help patients develop AD was influenced by many factors including age，experience of discussing AD with patients，and awareness of AD（P<0.05）. Conclusion　Age and awareness of AD are associated with physicians and nurses' intention of helping the patient to make AD. AD-related trainings may improve their intention level，so the trainings should be strengthened through various ways.

Key words: Medical staffs, Advanced directives, Living will, Health care proxy

马伟,薛青云. 医护人员对预先指示的态度及行为意向影响因素研究[J]. 中国全科医学, 2020, 23(31): 3935-3940. DOI: 10.12114/j.issn.1007-9572.2020.00.527.
MA Wei,XUE Qingyun. Factors Associated with Attitudes and Behavioral Intention Concerning Advance Directives among Physicians and Nurses　[J]. Chinese General Practice, 2020, 23(31): 3935-3940. DOI: 10.12114/j.issn.1007-9572.2020.00.527.

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