原发性肝癌诊断知情患者参与手术决策现状及影响因素研究

目的了解原发性肝癌诊断知情患者参与手术决策现状及影响因素。方法以决策期待量表(Control Preference Scale,CPS)为基础设计患者参与手术决策调查问卷,采用方便抽样法,对某三级甲等肝胆专科医院145例诊断知情的原发性肝癌术后患者进行问卷调查,并采用Spearmen相关分析及多元有序Logistic回归分析其影响因素。结果原发性肝癌诊断知情患者期望参与手术决策方式与实际参与方式的符合率57.2%;36.5%患者实际参与手术决策方式为家属全权代理型,41.4%为由医生决策的被动型,患者两种被动参与手术决策的实际大于其期望。患者期望家属参与手术决策程度与家属实际参与程度符合率55.9%,35.9%患者认为家属实际参与程度多于其期望。患者年龄、文化程度、人均月收入和是否首次手术等是患者实际参与方式的独立影响因素(P0.05)。年轻、文化程度高、家庭人均月收入高和非首次手术患者实际参与手术决策较高。结论原发性肝癌诊断知情患者在手术决策中处于被动地位,参与手术决策实际小于其期望;家属是患者手术决策的重要参与者,但家属实际参与程度超过患者期望其参与的程度。医护人员应评估患者决策需求,加强与患者及家属沟通,可率先在年龄较轻、文化程度较高且有参与决策意愿的患者中推进医生-患者-家属三方共享决策,保障其决策参与权与选择权。     

结直肠癌住院患者参与手术治疗决策的现况研究

目的描述结直肠癌住院患者在手术治疗决策过程中期望参与的情况、实际参与的情况以及两者的符合程度。方法以决策参与期待量表(Control Preference Scale,CPS)为基础设计问卷,对北京市2所三级甲等医院普通外科的113例结直肠癌术后患者进行调查。结果在决策过程中,患者期望家属参与程度与家属实际参与程度的符合率是60.2%(68/113),患者期望参与方式与患者实际参与方式的符合率是62.8%(71/113)。相比未造口患者和女性患者,有造口和男性患者的参与方式更加被动(χ2=7.978,P<0.05;χ2=9.854,P<0.05)。结论超过40%的结直肠癌患者依赖于医生做出治疗决定,患者期望家属参与程度与家属实际参与程度之间,以及患者期望参与方式与实际决策参与方式之间均存在不一致。建议医务人员加强与患者沟通,满足他们对治疗相关信息的需求,推动实现医患共同决策。     

泌尿系统肿瘤患者参与手术治疗决策的现状研究

目的探讨泌尿系统肿瘤患者参与手术治疗决策的现状,为提供良好服务提供依据。方法采用患者参与手术治疗决策情况调查问卷对190例泌尿系统肿瘤患者进行调查。采用符合率及Kappa值一致性评价分析实际情况与患者期望情况之间的一致程度。患者实际参与手术决策方式的影响因素分析采用Logistic回归分析。结果在患者手术治疗决策过程中,46.8%(89/190)期望被动型,41%(78/190)期望合作型,12.1%(8/113)期望主动型;期望与实际符合率为57.9%。付费方式中自费、年龄≤50岁、文化程度高是主动型参与手术决策的影响因素。结论医务人员应注意评估患者期望参与医疗决策的方式,重视与患者本人的沟通,满足他们参与决策的意愿,推动实现医患双方共同决策,从而促进医患关系更加和谐。     

心血管病介入治疗患者临床决策参与期望及实际参与度的研究

目的 了解心血管病介入治疗患者临床决策参与期望及实际参与度现状,分析其影响因素,为促进心血管病介入治疗患者参与临床决策提供理论依据。 方法 选取2021年11月至2022年4月同济大学附属东方医院收治的240例心血管病介入治疗患者,采用横断面调查方式收集患者一般资料、临床决策参与期望和实际参与程度。采用单因素分析、多元线性回归分析和多元Logistic回归分析探索其影响因素。 结果 心血管病介入治疗患者临床决策期望总得分为（50.62±10.33）分,临床决策实际参与程度高者占19.17%,参与程度低者占80.83%。 多元线性回归分析显示学历、婚姻状况、生育情况和是否首次接受介入治疗是患者参与临床决策期望的影响因素,解释变异总量27.00%;多元Logistic回归分析显示学历、是否知晓诊断名称、是否首次接受介入治疗是患者参与临床决策实际程度的影响因素。结论 心血管病介入治疗患者参与临床决策期望高,而实际参与程度低。学历、是否首次接受介入治疗等因素会影响病人临床决策参与的期望和程度。     

早期非小细胞肺癌患者参与手术决策现状调查及影响因素

目的:调查早期非小细胞肺癌患者参与手术治决策的期待、现状及影响因素。方法:用决策期待量表调查144例早期非小细胞肺癌患者参与决策现状,采用Logistic回归分析其参与决策的影响因素。结果:患者期待与实际参与手术治疗方式均为被动型占主导,治疗过程中患者期待与家属共同参与,主要与性别、性格、受教育程度、婚姻、病程、学历、付费方式、子女数有关。结论:早期非小细胞肺癌患者期待与实际参与手术决策及期待家属与家属实际参与程度之间均有统计学差异(P 0.01)。内向性格的患者期待被动参与,外向性格、受教育程度越高表现为合作型;职工医保的患者实际参与类型为主动型和合作型;子女数越多,参与方式越被动;已婚患者比较倾向于除家属全权代表的其他参与类型。子女数越少的患者期待家属合作型,反之期待家属主导型;内向性格患者期待主动型;而实际上家属在整个决策中为主导者。根据不同人格特质的患者,提供针对性指导,鼓励患者参与医疗安全。     

ICU患者家属满意度调查

目的了解ICU患者家属的感受,分析家属满意度的影响因素,为有效提高医疗护理质量提供参考依据。方法采用ICU家属满意度问卷（familysatisfactionwithcareintheintensivecareunit．FS—ICU）对129名ICU患者的家属进行问卷调查,对2名家属进行了访谈,总结患者家属对ICU的满意度情况,并分析其影响因素。结果ICU患者家属对ICU的满意度调查中总体满意度的均分为（85．86±20．18）分;患者家属对ICU的满意度的影响因素为关注家属需求、对家属礼貌尊重和感同身受、ICU的氛围、提供病情的真实程度、决策过程中得到的支持（t分别为2．980,4．118,3．704,2．539,2．871：P〈0．05）。结论医护人员对家属的尊重和满足需求、对患者感同身受的态度以及家属参与治疗决策并在决策中得到支持等均对提高家属满意度有非常积极的作用。努力改进和提高国内ICU服务理念及硬件设施,有助于提升医院整体的医疗、护理质量。     

ICU转出患者家属迁移应激现状及影响因素分析

目的 探究有关 ICU 转出患者家属的迁移应激现状及其影响因素。方法 选择我院 2020 年 1 月到 2022 年 10 月对 93 例 ICU 转出患者家属为邮寄地址。采取一般资料调查问卷、ICU 转出患者家属转科应激压力量表等进行问卷调查。采用多元回归分析 ICU 转出患者家属迁移应激的影响因素。结果 ICU 转出患者家属的迁移应激总分为（62.31±10.76）分。多元线性回归结果显 示，年龄、与患者夫妻关系、受教育程度低、ICU 住院时间为家属转科应激压力的影响因素（P<0.05）。结论 了解 ICU 转出患 者家属的迁移应激现状应的影响因素后应针对影响因素进行干预并制定相应的计划，从而提高患者家属的迁移应激水平，减少 患者家属转科压力。     

ICU临终患者家属是否选择放弃治疗的影响因素

目的 了解ICU临终患者家属对放弃治疗的真实看法及其影响因素.方法 采用质性研究中现象学描述性定性研究方法,以深度访谈方式收集7例ICU患者家属的个案资料,并运用Colaizzi分析程序进行分析.结果 经过分析,共提取5个方面的主题,并将其归纳为影响临终患者家属是否选择放弃治疗的促进因素和阻碍因素：（1）经济因素是ICU临终患者家属决定是否选择放弃治疗的最重要影响因素;（2）情感及道德因素是ICU临终患者家属放弃治疗的重要阻碍因素;（3）放弃治疗的决策权不明确是导致ICU临终患者家属选择放弃治疗的阻碍因素;（4）患者对自身的病情知晓率低是导致其自身无法进行临床决策的阻碍因素;（5）对患者生命的尊重和死亡观念的改变是ICU临终患者家属放弃治疗的重要促进因素.结论 ICU临终患者家属对放弃治疗的临床决策受到多种因素的影响,应该进一步完善医保制度,使更多的ICU临终患者不因经济原因而放弃或过度治疗;逐步建立由患者、家属和医护人员共同组成的决策共享模式,对患者实现个体化的病情告知,让更多的患者和家属主动参与到临床决策的过程中,缓解其家属因签署放弃治疗而导致的巨大心理压力.     

ICU转出早期重型颅脑创伤患者家属迁移应激现况及影响因素分析

目的 ：分析ICU转出早期重型颅脑创伤患者家属迁移应激现况及其影响因素,为制定有针对性的干预措施提供参考依据。方法 ：便利选取2021年11月至2022年8月从上海市某3家综合医院ICU转出的重型颅脑创伤患者家属共155名作为研究对象,采用一般情况调查表、ICU转出患者家属迁移应激量表、社会支持评定量表、家属照顾能力量表及简易应对方式量表进行调查。结果 ：ICU转出早期重型颅脑创伤患者家属迁移应激总分为（60.66±1.64）分;家属的性别、文化程度、ICU探视次数、社会支持、积极应对是ICU转出早期重型颅脑创伤患者家属迁移应激的主要影响因素（P<0.05）,共同解释其71.6%的变异水平。结论 ：ICU转出早期重型颅脑创伤患者家属的迁移应激处于中等偏上水平,医护人员应注重评估ICU转出早期家属的心理状况和需求,并根据影响因素制定个性化的干预措施,预防家属迁移应激的发生,或减轻其迁移应激水平。     

外科手术患者参与手术决策的现状及影响因素分析

目的 调查外科手术患者实际参与手术决策的现状并分析相关影响因素.方法 采用一般资料调查表、决策参与期待量表、医患关系问卷及患者参与能力量表,对大连市某三级甲等医院外科367例术后患者进行调查.结果 患者在实际手术决策过程中,主动型26例(7.1%);合作型167例(45.5%);被动型174例(47.4%).Logistic回归分析结果显示,主动型患者参与的影响因素为婚姻状况及职业;合作型患者参与的影响因素为文化程度及医患关系;被动型患者参与的影响因素为医疗付费方式及患者自身参与能力.结论 外科手术患者实际参与手术决策的方式以合作型和被动型为主,在临床工作中为提高患者参与水平,护理人员应以主要影响因素为切入点,从不同视角采取有针对性措施,增加患者满意度.     

Home care for terminally ill Turks and Moroccans and their families in the Netherlands: carers' experiences and factors influencing ease of access and use of services

The aim of this study was to explore the experiences of relatives of elderly terminally ill Turks and Moroccans regarding Dutch professional home care and the barriers to the use this care. Nine Turkish and ten Moroccan family members, who recently looked after dying members of their families, were interviewed using a semi-structured topic list. The data was analyzed using the method described by Glaser and Strauss. The results of this study make it clear that there is no uniform pattern in the use of home care. However, family members who did use home care facilities were all satisfied. Furthermore, on the basis of this study, several factors influencing access to and use of home care were discerned, e.g., illness, family structure, decision making, pressure from the community, information and formal referrals. In addition, the authors found that ‘preferences regarding family care’ influenced all former factors.     

Family caregivers' preferences in caring for their hospitalized elderly relatives

We know little about family preferences in participating in hospital care for elders. This pilot study was conducted to explore the kind of care actions that family caregivers prefer to do for their hospitalized elderly relatives. The instrument used was a 14-item questionnaire based on a qualitative study conducted by the author. The results indicated that 95% of these family caregivers (n = 40) would prefer to participate in 10 or more types of family care actions. The implications for nursing practice are discussed. Future research will focus on identifying factors influencing family preferences, the relationship between the preferences and actual performance, and how nurses can help family caregivers participate in the care they desire.     

ICU患者替代决策者决策疲劳现状及影响因素分析

目的 调查ICU患者替代决策者决策疲劳现状并分析其影响因素。方法 采用便利抽样法,2022年1月—10月,选取山东省某三级甲等医院314名ICU患者的替代决策者为调查对象。使用一般资料调查表、决策疲劳量表、决策准备量表、家庭成员决策自我效能量表、社会支持评定量表进行调查。结果 ICU患者的替代决策者决策疲劳量表得分为（12.33±4.88）分。多重线性回归分析结果显示,患者入住ICU天数、家庭人均月收入、替代决策者性别、文化程度、职业状态、是否了解该疾病、决策准备度、决策自我效能及主观支持是决策疲劳的影响因素。结论 ICU患者替代决策者决策疲劳处于中等水平;患者入住ICU天数较长、家庭人均月收入低、女性、文化程度高、在职、不了解该疾病的替代决策者的决策疲劳水平较高,提高决策准备度、决策自我效能感及主观支持水平有利于减轻替代决策者决策疲劳,改善其决策质量。     

222名颅内肿瘤患者家属决策冲突现状及影响因素分析

目的 调查颅内肿瘤患者家属决策冲突现状,分析其影响因素。方法 采用便利抽样法,于2021年9月—2022年2月选取乌鲁木齐市3所三级甲等医院符合纳入标准的222名颅内肿瘤患者家属作为研究对象。采用一般资料调查表、决策冲突量表、领悟社会支持量表和自我效能量表进行调查。采用多重线性回归分析颅内肿瘤患者家属决策冲突的影响因素。结果 本组颅内肿瘤患者家属决策冲突总分为（34.74±14.38）分,多重线性回归分析结果显示,患者肿瘤类型及患者家属经济压力、与医护讨论患者病情频率、领悟社会支持和自我效能进入回归方程（P<0.05）,共解释总变异的33.5%。结论 本组颅内肿瘤患者家属决策冲突处于中等偏下水平,患者肿瘤类型及患者家属经济压力、与医护讨论患者病情频率、领悟社会支持和自我效能是决策冲突的影响因素。医护人员应借助个性化、针对性的医疗决策辅助工具,改善患者家属的决策信心,降低其决策冲突水平。     

神经内科ICU患者家属疾病不确定感与决策冲突的 相关性分析

目的：探讨神经内科ICU患者家属疾病不确定感与决策冲突的相关性。方法：采用疾病不确定感家 属量表、家属决策冲突量表对156例神经内科ICU患者家属评分并进行相关性分析。结果：神经内科ICU 患者家属疾病不确定感得分为（89.17±17.13）分,决策冲突得分为（31.60±6.17）分;决策冲突与疾病不确定 感呈正相关（r=0.359,P＜0.05）。结论：神经内科ICU患者家属存在决策冲突,疾病不确定感处于中水平,决 策冲突与疾病不确定感呈正相关。     

Life-sustaining treatment decisions in the ICU for patients with ESLD: A prospective investigation

We conducted a prospective study in the ICU of life‐sustaining treatment and comfort care decisions over time in patients with end‐stage liver disease (ESLD) from the perspectives of patients, family members, and healthcare professionals. Six patients with ESLD, 19 family members, and 122 professionals participated. The overarching theme describing the decision‐making process was “on the train.” Four sub‐themes positioned patients and family members as passengers with limited control, unable to fully understand the decision‐making process. Findings suggest that including patients and family members in non‐immediate life‐saving decisions and verifying early on their understanding may help to improve the decision‐making process. © 2012 Wiley Periodicals, Inc. Res Nurs Health 35:518–532, 2012     

癌症患者身心健康状况与其临床决策倾向性的相关性

目的了解癌症患者身心健康状况与临床决策中对医生、患者及家属意见倾向性的相关性。方法选取2008年9月至12月在北京市某三级甲等肿瘤专科医院内科住院治疗的120例癌症患者进行问卷调查。结果经非参数检验,血常规结果不同,癌症患者的临床决策倾向性不同(P0.05);经Spearman相关分析,病程、欧洲五维健康量表得分、欧洲五维直观式健康量表得分和卡氏评分与癌症患者的临床决策倾向性有关。心理健康状况与临床决策倾向性不相关(P0.05)。结论癌症患者身体健康状况与临床决策倾向性相关,但未发现心理健康状况与临床决策倾向性的相关性。     

Do-not-resuscitate decision making for terminally ill older patients in the emergency department: An explorative,descriptive inquiry of Chinese family members

Many terminally ill older adults depend on family members to make medical decisions in China. Many family members find it difficult to make do-not-resuscitate (DNR) decisions in emergency departments (ED). Currently, factors that affect DNR decision making by family members for older adults needing emergency care have not been well studied. This qualitative inquiry explores factors influencing DNR decision-making among family members of terminally ill older adults in ED. Semi-structured in-depth interviews were conducted for a 12-family member of terminally ill older adults at ED in China. Results of the conventional content analysis showed that family members made DNR decisions based on a wide of reasons: (a) subjective perception of family members, (b) conditions of the terminally ill older adults, (c) external environmental factors, and (d) internal family factors. The findings of this study expand our knowledge and understanding of factors influencing DNR decision-making by family members of terminally ill older adults in ED.     

Finnish nurses' perceptions of care of older patients

The aim of the study was to explore how far the perceptions of care of nurses in Finland take into account the preferences of the older patient and the patient's family members and to evaluate related background factors. The data were collected by questionnaire with nurses (n = 167) working in a geriatric hospital. The questionnaire contained items about shared decision‐making, attitudes to nursing patients, assessment of patients' functional ability and need for care, goal‐setting, evaluation of outcomes and discharge planning. This study showed that taking into account the preferences of the patient and the patient's family members regarding the patient's care was challenging for the nurses in practice. About one‐third of the nurses reported making the decisions on a patient's care themselves and not respecting patient autonomy in situations where patients are not able to assess their own situation. In addition, the nurses reported asking for the views of patients less frequently than those of family members when assessing and setting patient care goals. In practice, nurses need to be aware of this, during the transition from routine‐centred care to patient‐centred care.     

ICU research: the impact of invasiveness on informed consent

Purpose

Studies into the preferences of patients and relatives regarding informed consent for intensive care unit (ICU) research are ongoing. We investigated the impact of a study’s invasiveness on the choice of who should give consent and on the modalities of informed consent.

Methods

At ICU discharge, randomized pairs of patients and relatives were asked to answer a questionnaire about informed consent for research. One group received a vignette of a noninvasive study; the other, of an invasive study. Each study comprised two scenarios, featuring either a conscious or unconscious patient. Multivariate models assessed independent factors related to their preferences.

Results

A total of 185 patients (40 %) and 125 relatives (68 %) responded. The invasiveness of a study had no impact on which people were chosen to give consent. This increased the desire to get more than one person to give consent and decreased the acceptance of deferred or two-step consent. Up to 31 % of both patients and relatives chose people other than the patient himself to give consent, even when the patient was conscious. A range of 3 to 17 % of the respondents reported that they would accept a waiving of consent. Younger respondents and individuals feeling coerced into study participation wanted to be the decision makers.

Conclusions

Study invasiveness had no impact on patients’ and relatives’ preferences about who should give consent. Many patients and relatives were reluctant to give consent alone. Deferred and two-step consent were less acceptable for the invasive study. Further work should investigate whether sharing the burden of informed consent with a second person facilitates participation in ICU research.