晚期癌症患者家属需求调查表的制定及信效度评价

目的制定晚期癌症患者家属需求调查表，并进行信效度分析。方法通过文献回顾、临床观察、专家咨询及预调查法制定晚期癌症患者家属需求调查表，通过90例小样本调查，进行探索性因素分析对调查表初稿优化，修改后定稿，于2007年7—12月对上海市15所医院共649名自愿参与本研究的晚期癌症住院患者家属进行大样本调查，分析调查表的信度和效度。结果制定的《晚期癌症患者家属需求调查表》包括家属自身健康、医护相关行为、疾病知识、丧葬支持、临终关怀知识、对患者心理支持和对患者症状控制7个纬度共36个需求项目。调查表总的Cronbach’s α系数为0．902，各纬度Cronbach’s α系数为0．785-0．893，验证了调查表的信度。内容效度统计分析显示各项目与总分的相关性均有统计学意义（P〈0．01）。因子分析提取7个公因子解释总方差为66．148％，方差最大正交旋转后各项目载荷均大于0．5；各纬度之间、各纬度与总分之间均存在显著的相关性（P〈0．01），充分验证了调查表的结构效度。结论本研究制定的晚期癌症患者家属需求调查表具有较好的信度和效度，可用于我国晚期癌症住院患者家属的需求调查。     

满足家属医学知识需求对提高晚期癌症患者生活质量的影响

目的 探讨满足家属医学知识需求对晚期癌症患者生活质量的影响.方法 采用问卷形式,调查500名癌症患者家庭中的主要照顾者对有关照顾患者的咨询需求,以及满足需求并在其进行培训前后对患者护理干预效果的比较.结果 家属最希望能根据患者的疾病、症状及生理需求进行照顾,最大限度满足患者生理及心理的需求.结论 根据患者家属的需求提供切实有效的医疗护理常识培训,使家属更好地掌握照顾患者的技巧是提升晚期癌症患者生活质量的重要手段.     

满足家属医学知识需求对提高晚期癌症患者生活质量的影响

目的 探讨满足家属医学知识需求对晚期癌症患者生活质量的影响.方法 采用问卷形式,调查500名癌症患者家庭中的主要照顾者对有关照顾患者的咨询需求,以及满足需求并在其进行培训前后对患者护理干预效果的比较.结果 家属最希望能根据患者的疾病、症状及生理需求进行照顾,最大限度满足患者生理及心理的需求.结论 根据患者家属的需求提供切实有效的医疗护理常识培训,使家属更好地掌握照顾患者的技巧是提升晚期癌症患者生活质量的重要手段.     

满足家属医学知识需求对提高晚期癌症患者生活质量的影响

目的 探讨满足家属医学知识需求对晚期癌症患者生活质量的影响.方法 采用问卷形式,调查500名癌症患者家庭中的主要照顾者对有关照顾患者的咨询需求,以及满足需求并在其进行培训前后对患者护理干预效果的比较.结果 家属最希望能根据患者的疾病、症状及生理需求进行照顾,最大限度满足患者生理及心理的需求.结论 根据患者家属的需求提供切实有效的医疗护理常识培训,使家属更好地掌握照顾患者的技巧是提升晚期癌症患者生活质量的重要手段.     

满足家属医学知识需求对提高晚期癌症患者生活质量的影响

目的 探讨满足家属医学知识需求对晚期癌症患者生活质量的影响.方法 采用问卷形式,调查500名癌症患者家庭中的主要照顾者对有关照顾患者的咨询需求,以及满足需求并在其进行培训前后对患者护理干预效果的比较.结果 家属最希望能根据患者的疾病、症状及生理需求进行照顾,最大限度满足患者生理及心理的需求.结论 根据患者家属的需求提供切实有效的医疗护理常识培训,使家属更好地掌握照顾患者的技巧是提升晚期癌症患者生活质量的重要手段.     

满足家属医学知识需求对提高晚期癌症患者生活质量的影响

目的 探讨满足家属医学知识需求对晚期癌症患者生活质量的影响.方法 采用问卷形式,调查500名癌症患者家庭中的主要照顾者对有关照顾患者的咨询需求,以及满足需求并在其进行培训前后对患者护理干预效果的比较.结果 家属最希望能根据患者的疾病、症状及生理需求进行照顾,最大限度满足患者生理及心理的需求.结论 根据患者家属的需求提供切实有效的医疗护理常识培训,使家属更好地掌握照顾患者的技巧是提升晚期癌症患者生活质量的重要手段.     

满足家属医学知识需求对提高晚期癌症患者生活质量的影响

目的 探讨满足家属医学知识需求对晚期癌症患者生活质量的影响.方法 采用问卷形式,调查500名癌症患者家庭中的主要照顾者对有关照顾患者的咨询需求,以及满足需求并在其进行培训前后对患者护理干预效果的比较.结果 家属最希望能根据患者的疾病、症状及生理需求进行照顾,最大限度满足患者生理及心理的需求.结论 根据患者家属的需求提供切实有效的医疗护理常识培训,使家属更好地掌握照顾患者的技巧是提升晚期癌症患者生活质量的重要手段.     

满足家属医学知识需求对提高晚期癌症患者生活质量的影响

目的 探讨满足家属医学知识需求对晚期癌症患者生活质量的影响.方法 采用问卷形式,调查500名癌症患者家庭中的主要照顾者对有关照顾患者的咨询需求,以及满足需求并在其进行培训前后对患者护理干预效果的比较.结果 家属最希望能根据患者的疾病、症状及生理需求进行照顾,最大限度满足患者生理及心理的需求.结论 根据患者家属的需求提供切实有效的医疗护理常识培训,使家属更好地掌握照顾患者的技巧是提升晚期癌症患者生活质量的重要手段.     

满足家属医学知识需求对提高晚期癌症患者生活质量的影响

目的 探讨满足家属医学知识需求对晚期癌症患者生活质量的影响.方法 采用问卷形式,调查500名癌症患者家庭中的主要照顾者对有关照顾患者的咨询需求,以及满足需求并在其进行培训前后对患者护理干预效果的比较.结果 家属最希望能根据患者的疾病、症状及生理需求进行照顾,最大限度满足患者生理及心理的需求.结论 根据患者家属的需求提供切实有效的医疗护理常识培训,使家属更好地掌握照顾患者的技巧是提升晚期癌症患者生活质量的重要手段.     

满足家属医学知识需求对提高晚期癌症患者生活质量的影响

目的 探讨满足家属医学知识需求对晚期癌症患者生活质量的影响.方法 采用问卷形式,调查500名癌症患者家庭中的主要照顾者对有关照顾患者的咨询需求,以及满足需求并在其进行培训前后对患者护理干预效果的比较.结果 家属最希望能根据患者的疾病、症状及生理需求进行照顾,最大限度满足患者生理及心理的需求.结论 根据患者家属的需求提供切实有效的医疗护理常识培训,使家属更好地掌握照顾患者的技巧是提升晚期癌症患者生活质量的重要手段.     

Distress of inpatients with terminal cancer in Japanese palliative care units: from the viewpoint of spirituality

A qualitative study was conducted in an attempt to improve our understanding of the spiritual distress of terminally ill cancer patients in Japan. The subjects were inpatients at four approved palliative care units in Japan. The patients were interviewed and they expressed their own experiences in which spirituality was considered to be identifiable. Literal records of the interviews were analyzed using constant comparative analyses as proposed in relation to the grounded theory approach. The analysis included 11 inpatients and a variety of expressions of distress were obtained. After the conditions of the subjects were evaluated in order to search for common factors related to distress, consciousness of the gap between the patient's aspirations and the present situation were found to cause gap-induced distress. Distress was classified into three categories: distress due to the gap between the present situation and how the individual wanted to live, how the individual wished to die, and the individual's wish to maintain relations with others. The aspirations causing the gap were then interpreted from the viewpoint of spirituality as "anchors in life" for Japanese patients with terminal cancer. It was also revealed that in patients who possessed pictures of how they wished to die as their "anchors in life" and who were in a severe physical condition, distress increased and they became confused after their physical symptoms were relieved following admission to PCU.     

住院患者16例自杀原因分析及其安全警示

目的分析住院患者自杀原因、方式、时间、场所等,为防止住院患者自杀、提高病房安全管理提供依据。方法采取病例分析和结构性访谈方法,对某医院2007年7月至2011年7月16例自杀患者发生的原因、方式、时间等进行调查分析。结果住院自杀患者中,晚期癌症占68.75%,坠楼自杀者占56.25%;女性占68.75%,中老年占62.5%,初中以下文化程度占87.5%。结论晚期恶性肿瘤、女性、中年以上和文化程度低的患者是住院患者自杀的高危人群,坠楼是常见的自杀方式。应加强对自杀高危人群的关注,加强对病房设施及危险物品器械的管理,以进一步提高医院的安全管理。     

晚期肝癌患者家属照顾者承受压力与应对方式的相关性研究

目的 描述晚期肝癌患者家属照顾者的压力水平、应对方式情况,并探讨两者之间的关系。方法 采用描述性相关性研究设计,调查70名晚期肝癌患者家属照顾者,并在相同医院调查80名中期肝癌患者家属照顾者作为对照。结果 晚期肝癌患者家属照顾者的总体压力水平为中度,明显高于中期肝癌患者家属照顾者（P〈0．01）;两组应对压力的方式无统计学差异;晚期肝癌患者家属照顾者的积极应对与其压力水平呈负相关（P〈0.05）,消极应对与其压力水平呈正相关（P〈0．01）。结论 晚期肝癌患者家属照顾者普遍存在中度水平压力,积极应对有助于降低其压力,消极应对则可加重家属照顾者的压力。     

舒适护理对癌症晚期病人生活质量影响的研究

[目的]探讨舒适护理对癌症晚期病人生活质量(QOL)的影响。[方法]将56例住院癌症晚期病人按照住院顺序分为研究组和对照组,各28例。研究组在整体护理基础上由护理质控小组(QC)实施舒适护理干预,对照组按常规进行整体护理,观察干预前后两组病人生活质量情况。[结果]研究组病人接受护理干预后在生活质量总分及其子项目,如食欲、精神、睡眠、疼痛、对治疗的态度、对癌症的认识、家庭的理解与配合、治疗副反应方面评分均高于对照组(P<0.05或P<0.01);研究组口服吗啡的日平均用量大于对照组,疼痛控制良好(P<0.01)。[结论]舒适护理干预可以提高癌症晚期病人的生活质量。     

Quality of final care for terminal cancer patients in a comprehensive cancer centre from the point of view of patients' families

The aim of this study was to evaluate the quality of care for terminal cancer patients at our institution, as assessed by families in a questionnaire sent 6 months after the death of the patient. We evaluated the quality of information given to the patients and to their families, the patients' comfort at the end of their lives (nursing, pain, psychological support) and the families' opinions about the practical conditions at the time of death (in our institution or at home). A total of 105 consecutive patients who died in our institution between January and June 1989 were included in the study; the vast majority had breast or head and neck cancers. We obtained a total of 48 answers from the 105 families that received the questionnaire. Of these, 87.5% were satisfied with the terminal nursing care, 77% were satisfied with the information given to patients and 60% with the information given to families. The treatment for pain was considered to be inefficient or incomplete by 21% of the families; 32 families (67%) considered that the death of terminal cancer patients should occur in the hospital where the patient had been treated and 12% felt that it should occur at home. This study led us to examine various means for improving the quality of care for our terminal cancer patients.     

舒适护理对癌症晚期病人生活质量影响的研究

[目的]探讨舒适护理对癌症晚期病人生活质量（QOL）的影响。[方法]将56例住院癌症晚期病人按照住院顺序分为研究组和对照组,各28例。研究组在整体护理基础上由护理质控小组（QC）实施舒适护理干预,对照组按常规进行整体护理,观察干预前后两组病人生活质量情况。[结果]研究组病人接受护理干预后在生活质量总分及其子项目,如食欲、精神、睡眠、疼痛、对治疗的态度、对癌症的认识、家庭的理解与配合、治疗副反应方面评分均高于对照组（P〈0.05或P〈0.01）;研究组口服吗啡的日平均用量大于对照组,疼痛控制良好（P〈0.01）。[结论]舒适护理干预可以提高癌症晚期病人的生活质量。     

Comparison between fatigue, sleep disturbance, and circadian rhythm in cancer inpatients and healthy volunteers: evaluation of diagnostic criteria for cancer-related fatigue

The aim of this study was to evaluate whether diagnostic criteria for cancer-related fatigue syndrome (CRFS) could be rigorously applied to cancer inpatients, and to explore the relationship between subjective fatigue and objective measures of physical activity, sleep, and circadian rhythm. Female cancer patients (n=25) and a comparison group of subjects without cancer (n=25) were studied. Study participants completed a structured interview for CRFS and questionnaires relating to fatigue, psychological symptoms, and quality of life (QoL). Wrist actigraphs worn for 72 hours were used as an objective measure of activity, sleep, and circadian rhythm. Compared to controls, cancer patients were more fatigued, had worse sleep quality, more disrupted circadian rhythms, lower daytime activity levels, and worse QoL. After exclusion of subjects with "probable" mood disorders, the prevalence of CRFS was 56%. Fatigue severity among the cancer patients was significantly correlated with low QoL, depression, constipation, and decreased self-reported physical functioning. It can be concluded that the diagnostic criteria for CRFS can be applied to cancer inpatients but strict application requires a rigorous assessment of psychiatric comorbidity. Despite cancer inpatients having greater impairments of sleep and circadian rhythm, it was found that fatigue severity did not appear to be related to these impairments.     

The quality of supportive care among inpatients dying with advanced cancer

Purpose

Managing symptoms and communicating effectively are essential aspects of providing high-quality cancer care, especially among patients with advanced cancer. The purpose of this study is to apply novel quality indicators to measure the quality of supportive care provided to patients with advanced cancer who died in a large university medical center.

Methods

Cancer quality ASSIST is a comprehensive quality indicator (QI) set that includes 92 symptom and care planning indicators, of which we piloted 15 applicable to persons with advanced cancer who died in the hospital setting. We evaluated medical records of all adult terminal hospitalizations with lengths of stay ≥3?days at one university medical center between April 2005 and April 2006.

Results

Of 496 decedents, 118 had advanced cancer (mean age 60, 54?% male). Forty-five percent received chemotherapy or radiation in the month prior to or during admission. During the hospitalization, 56?% of the patients spent time in the ICU (median length of stay 8?days), one in five received first-time hemodialysis, and 23?% had a ventilator withdrawn anticipating death. The 118 patients triggered 596 quality indicators of which 476 passed (QI level pass rate 80?%, range 50–100?%). Pain assessment and management were consistently performed; however, other cancer supportive care needed improvement: 26?% of patients not receiving cancer therapy who had nausea and vomiting received inadequate follow-up, more than one quarter of patients with dyspnea had this symptom inadequately addressed, and 29?% of patients taking long-acting opioids were not prescribed a bowel regimen. Timely discussion of patient preferences upon admission to the ICU or initiation of mechanical ventilation occurred in 64 and 69?% of cases, respectively.

Conclusions

This set of quality indicators can evaluate the quality of supportive and end-of-life care provided to inpatients dying with advanced cancer and identify aspects of care that need improvement.     

居家老年临终患者主要照顾者照护需求的调查

目的 调查居家老年临终患者主要照顾者照护需求并探究其影响因素.方法 对214名居家老年临终患者主要照顾者采用Katzs ADL量表和自设居家老年临终患者主要照顾者照护需求调查表进行问卷调查.结果 居家老年临终患者主要照顾者照护需求总分为(94.86±10.03)分,各维度中以医疗照护需求得分最高,约为(27.04±3.32)分,精神慰藉需求得分最低,约为(21.95±3.01)分;性别、家庭照护负担程度及自感健康状况是影响居家老年临终患者主要照顾者照护需求的主要影响因素(均P<0.01).结论 居家老年临终患者主要照顾者照护需求呈中上水平,且受多个因素影响.医护人员应进行综合评估,制定个性化服务方案以满足居家老年临终患者主要照顾者的照护需求,共同提高老年临终患者及主要照顾者的生活质量.