Chinese Medical Sciences Journal ›› 2018, Vol. 33 ›› Issue (4): 221-227.doi: 10.24920/003509

• 论著 • 上一篇    下一篇

中国临床医生对舒缓医疗的认知调查

向奕蓉,宁晓红   

  1. 中国医学科学院北京协和医学院北京协和医院老年医学科,北京100730
  • 收稿日期:2018-09-16 接受日期:2018-11-05 出版日期:2018-12-30 发布日期:2019-01-10

Recognition of Palliative Care in Chinese Clinicians: How They Feel and What They Know

Xiang Yirong,Ning Xiaohong   

  1. Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2018-09-16 Accepted:2018-11-05 Published:2018-12-30 Online:2019-01-10

摘要:

目的 调查中国临床医生在对末期患者提供医疗照护时的感受,对舒缓医疗理念的认知程度、以及舒缓医疗理念对他们临床实践的影响。方法 采用问卷调查形式,通过社交平台在10省市1500名不同医院和科室的临床医生发放调查问卷,内容涉及临床医生的基本信息,对舒缓医学熟悉程度的自我评价,既往参加缓和医疗培训和死亡教育,对照护末期患者的情感态度,以及临床实践的态度等。分析与医生情感态度相关的因素,以及医生知悉缓和医疗对他们临床实践方式的影响。统计方法采用Logistic 回归分析和卡方检验。结果 共有379名临床医生完成了有效问卷。其中66.8%(253/375)参加过两次以上舒缓医疗课程培训。66.75%(253/379)在面对末期患者时感到有无力感。临床医生舒缓医学相关教育经历与其对舒缓医学的认知程度显著相关(OR=6.923,P=0.002)。知悉舒缓医疗的临床医生在面对末期患者时较少产生负面情绪(χ 2=13.512,P<0.001),并且他们能在临床医疗照护工作中更关注患者本人的意愿和患者家属感受(χ 2=28.754,P<0.001, χ 2=24.406,P<0.001)。 结论 中国临床医生在面对末期患者的临床照护工作中普遍有无力感。舒缓医学的理念有助于临床医生克服这种负面感受并且在临床工作中更尊重患者意愿及关注患者家属的想法。未来应开展更适合中国国情的舒缓医学教育,以提高临床医生对舒缓医学的认知程度。

关键词: 舒缓医学, 认知, 中国, 肿瘤内科医生

Abstract:

Objective To investigate doctors’ feelings when providing medical care to end-stage patients, and their understanding as well as reflection about theoretical concepts of palliative medicine. Methods Questionnaires were delivered through a social networking platform to 1500 clinicians of different specialties in 10 proviences of China. It covered issues of background information, self-assessment of familiarity to palliative care, prior training history, emotional attitude toward end-stage patients, and the reflections on clinical practice. Logistic regression analysis and chi-square test were used to analyse the categorical variables. Results There were 379 clinicians who completed the questionnaires and submitted successfully. Among them, 66.8% (253/379) had attended palliative care training courses more than twice; 66.8% (253/379) clinicians percieved powerless feeling when facing end-stage patients. We found that the education on palliative medicine was significantly associated to doctors’ better comprehension on the concept of palliative care (OR=6.923, P=0.002). Doctors who were more familiar with palliative medicine were less likely to perceive powerless feelings (χ 2=13.015, P<0.001), and would be more likely to concern about patients and their family members in their clinical work (χ 2=28.754, P<0.001, χ 2=24.406, P<0.001). Conclusion The powerless feeling is prevalent in Chinese doctors when facing end-stage patients. Palliative care help them overcome the negative feelings and act more caring in clinic. More careful designed educational strategies that adapt to Chinese actual situation are needed to improve doctors’ cognition on palliative care.

Key words: palliative care, recognition, China, oncologist

基金资助: 北京协和医学院教改立项课题(2015zlgc0120)

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