摘要
目的:调查老年住院患者及家属对预立医疗照护计划(ACP)的态度及其影响因素。方法:采用方便抽样方法,以问卷的形式调查197例住院患者及248例患者家属,分析患者和家属对于衰弱状态下进行营养支持、终末期进行高级生命支持态度的差异以及制定生前预嘱意愿的影响因素。结果:与住院患者相比,家属听说过ACP/预设医疗指示(ADs)的比例[58.9%(146/248)和41.6%(82/197),χ^2=13.070,P=0.000]、谈论过死亡话题的比例[89.9%(223/248)和55.3%(109/197),χ^2=69.334,P=0.000]、会考虑制定生前预嘱的比例[88.7%(220/248)和46.7%(92/197),χ^2=92.461,P=0.000]、愿意了解自己真实病情的比例[97.2%(241/248)和89.8%(177/197),χ^2=10.349,P=0.001]均显著升高。对于留置鼻胃管、进行胃肠造瘘、留置深静脉导管的态度,家属对于老年人的选择相对于患者本人更加积极(χ^2=42.996、11.446、27.704,P=0.000、0.003、0.000),对于终末期高级生命支持的方式(有创呼吸支持、心脏按压及电除颤、肾脏替代),患者本人及家属对于老年人态度的差异无统计学意义(χ^2=0.569、1.866、4.337,P=0.752、0.393、0.114),但均提示不同意的比例更高。与患者制定生前预嘱意愿相关的影响因素为对ACP/ADs的知晓(OR=0.187,95%CI:0.096~0.366,P=0.000)以及曾经与家人谈论过死亡话题(OR=0.450,95%CI:0.231~0.878,P=0.019)。结论:我国老年住院患者中愿意制定生前预嘱的比例偏低,与此相关的影响因素为对生前预嘱的知晓以及曾经与家人谈论过死亡话题,因此我们应该加强对生前预嘱的推广和教育。
Objective To survey the attitudes and influencing factors towards advance-care planning(ACP)among elderly inpatients and their family members.Methods A total of 197 elderly inpatients and 248 family members were enrolled by using a convenience sampling method,and they were investigated by a questionnaire.The differences in attitudes towards the nutrition support in the state of frailty and the advanced life support at the end of life between patients and their family members,and the influencing factors for making a living will were analyzed.Results Compared with elderly inpatients,the proportions of their family members,who had heard of ACP/advance directives(ADs)(58.9%or 146/248 vs.41.6%or 82/197,χ^2=13.070,P=0.000),who had discussed death(89.9%or 223/248 vs.55.3%or 109/197,χ^2=69.334,P=0.000),who would make a living will(88.7%or 220/248 vs.46.7%or 92/197,χ^2=92.461,P=0.000),who would know the true condition(97.2%or 241/248 vs.89.8%or 177/197,χ^2=10.349,P=0.001),were significantly elevated.Towards the choice of tube feeding,percutaneous endoscopic gastrojejunostomy and deep-vein catheter insertion,family members had more positive attitudes than did patients themselves(χ^2=42.996,11.446 and 27.704,P=0.000,0.003 and 0.000).Towards the life support during end-of-life including ventilator-assisted ventilation,electric defibrillation,extracorporeal cardiac compression and hemodialysis,there was no significant difference in attitudes between patients and family members(χ^2=0.569,1.866 and 4.337,P=0.752,0.393 and 0.114),and the proportion of disapproval was higher in family members.The influencing factors for making a living will were the awareness of ACP/ADs(OR=0.187,95%CI:0.096-0.366,P=0.000)and having discussed death with family members(OR=0.450,95%CI:0.231-0.878,P=0.019).Conclusions The proportion of elderly inpatients who are willing to make a living will is low in China,and its influencing factors are the awareness of ACP/ADs and having discussed death with family members.Thus,the promotion and education of ACP/ADs should be strengthened.
作者
沈姞
武文斌
刘洋
张玄
李晶
施红
Shen Ji;Wu Wenbin;Liu Yang;Zhang Xuan;Li Jing;Shi Hong(Department of Geriatrics,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2020年第6期653-657,共5页
Chinese Journal of Geriatrics
基金
北京医院院级课题资助(bj-2018-005)。
