中国临床医生对舒缓医疗的认知调查

doi:10.24920/003509

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The survey in this study found 66.8% Chinese clinicians feel powerless while facing end-stage patients. Education on palliative medicine in clinicians were associated with less negative feelings, but more careful designations are needed.

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

Funding: Supported by the Educational Reform Project of Peking Union Medical College(2015zlgc0120)

Xiang Yirong,Ning Xiaohong. Recognition of Palliative Care in Chinese Clinicians: How They Feel and What They Know[J].Chinese Medical Sciences Journal, 2018, 33(4): 221-227.

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Figure 1.

References 13

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Basic information	Q1	Your age
	Q2	Your specialty
	Q3	Do you have membership of a palliative care association
	Q4	What is the type of hospital you are working in
	Q5	Where does the hospital you are working locate (Beijing, others)
	Q6	How long is your clinical experience as a doctor (<15 years, ≥15 years)
	Q7	Your religion
Prior training history	Q8	How many times have you ever attended palliative care training (<2 times, or ≥2 times)
Prior training history	Q9	Have you ever attended education course on death? (true or false)
Personal experiences	Q10	Self-experience in family member’s death (true or false)
	Q11	Talking about death at physician’s own home (never, tried to avoid, discussed reluctantly, or discussed openly)
	Q12	Number of patient’s death each month?
Self-assessment of familiarity	Q13	Are you familiar with palliative care?
Self-assessment of familiarity	Q14	Are you familiar with the Living Will?
Emotional attitude	Q15	How do you feel when facing end-stage patients (multiple choices)
Reflection on their clinical practice	Q16	Patients’ own opinion was considered when discussing treatment with patients’ family.
	Q17	Agree that doctor should concern about patients’ family members?
	Q18	Which is better way to treat end-stage patients? (traditional care, or palliative care)

Characteristics	n	(%)	Feel powerless (n)		Χ²	P
Characteristics	n	(%)	Yes	No	Χ²	P
Specialty
Medical oncology	272	71.8	176	96	1.822	0.185
Others	107	28.2	77	30
Member of a palliative care association
Yes	110	29.0	61	49	8.917	0.003
No	269	71.0	192	77
Hospital level
Tertiary hospital	321	84.7	211	110	0.988	0.365
Non-teriary hospital	58	15.3	42	16
Location of hospital
Beijing	76	20.1	49	27	0.223	0.683
Non-capital cities	303	80.0	204	99
Working experience
≤15 years	201	53.0	145	56	5.591	0.022
>15 years	178	47.0	108	70
Religion
Non-religious	325	85.0	214	111	0.848	0.436
Religious	54	15.0	39	15
Previous attended palliative care course
≥2 times	253	66.8	155	98	10.334	0.001
<2 times	126	33.2	98	28
Whether attended courses on the death
Yes	83	21.9	38	45	21.061	<0.001
No	296	78.1	215	81
Whether experienced family member’s death
Yes	300	79.2	192	108	4.921	0.031
No	79	20.8	61	18
Atmosphere talking about death at home
Openly	128	33.8	78	50	2.947	0.106
Seldom	251	66.2	175	76
Number of patient death
>2 cases/ month	144	38.0	92	52	0.859	0.370
≤2 cases/ month	235	62.0	161	74
sum	379	100	253	126

Characteristics of doctors	Palliative care		Living will
Characteristics of doctors	OR	P value	OR	P value
Age	0.999	0.949	0.975	0.340
Specialty	1.042	0.920	0.823	0.687
Religion	1.270	0.599	1.225	0.700
Member of palliative care associations	3.228	<0.001	3.062	0.007
Hospital level	2.710	0.066	2.171	0.264
location of working hospital	1.529	0.254	1.825	0.159
Years of working experience	1.292	0.476	1.022	0.969
Attending courses on palliative care	6.923	0.002	1.781	0.409
Attending courses on the death	5.582	<0.001	7.340	<0.001
Experienced family member’s death	0.829	0.649	1.202	0.746
Atmosphere when talking about death at home	1.468	0.237	1.657	0.194
Number of patient death each month	1.332	0.372	1.039	0.923

Questions and responses	Familiar with palliative care		χ²	P value
Questions and responses	Yes (n=90) n(%)	No (n=289) n(%)	χ²	P value
Q15: How do you feel when facing end-stage patients?
Powerless	46(51.1)	207(71.6)	13.015	<0.001
Others	44(48.9)	82(28.4)	13.015	<0.001
Q16: Do you considert patients’ own willing for treatment?
1	2(2.2)	18(6.2)	28.754	<0.001
2	8(8.9)	78(27.0)
3	33(36.7)	121(41.9)
4	47(52.2)	72(24.9)
Q17: Do you agree that doctors should concern about patients’ family members?
1	0(0)	4(1.4)	24.406	<0.001
2	1(1.1)	7(2.4)
3	6(6.7)	60(20.8)
4	12(13.3)	74(25.6)
5	71(78.9)	144(49.8)
Q18: Which do you think is better way to treat end-stage patients?
Palliative care	86(95.6)	236(81.6)	10.764	0.005
Traditional care	4(4.4)	53(18.4)	10.764	0.005

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