护理学报 ›› 2020, Vol. 27 ›› Issue (12): 28-32.doi: 10.16460/j.issn1008-9969.2020.12.028
932名武汉市民对生命维持治疗的态度现状及影响因素分析
林慧菁, 倪平
- 华中科技大学同济医学院 护理学院,湖北 武汉 430030
Current Status of Attitudes to Life-sustaining Treatment in Citizens and Its Influencing Factors: A 932-case Study
LIN Hui-jing, NI Ping
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
摘要： 目的 探讨武汉市民对生命维持治疗的态度,分析其影响因素。方法 采用便利抽样法,2018年6月—2019年1月抽取武汉成年市民932名,采用一般资料调查表及生命维持治疗调查表对其进行调查,采用二分类Logistic回归分析生命维持治疗态度的影响因素。结果 932名市民中,600名（64.4%）听说过生命维持治疗,842名（90.3%）在假设病情严重或陷入昏迷时拒绝接受这些治疗。二分类Logistic回归分析显示,未患绝症（OR=2.153,P<0.001）的市民倾向于接受生命维持治疗,年龄越大（50~59岁：OR=0.472,P=0.028;≥60岁：OR=0.402,P=0.013）、大专及以上学历（OR=0.526,P=0.009）、患有绝症（OR=0.542,P=0.037）的市民越倾向于拒绝生命维持治疗。结论 本研究中64.4%市民听说过生命维持治疗,90.3%倾向于拒绝生命维持治疗,年龄、教育程度、是否患绝症是对生命维持治疗态度的主要影响因素。建议加强对生命维持治疗局限性的宣教,以帮助市民理解其本质,做出理性选择,提高生命质量。
中图分类号:
- R47
| [1] 倪平,曾铁英,夏莹,等. 1392名养老院老人对生命维持治疗的态度及影响因素分析[J]. 护理研究, 2014,28(10B):3604-3607. DOI:10.3969/j.issn.10096493.2014.029.007. [2] Kwok T, Twinn S, Yan E.The Attitudes of Chinese Family Caregivers of Older People with Dementia towards Life Sustaining Treatments[J].J Adv Nurs,2007,58(3):256-262. DOI:10.1111/j.1365-2648.2007.04230.x. [3] Liu TW, Wen FH, Wang CH, et al.Terminally Ill Taiwanese Cancer Patients’ and Family Caregivers’ Agreement on Patterns of Life-sustaining Treatment Preferences Is Poor to Fair and Declines Over a Decade: Results from Two Independent Cross-sectional Studies[J]. J Pain Symptom Manage,2017,54(1):35-45. DOI:10.1016/j.jpainsymman. [4] Reisfield GM, Wallace SK, Munsell MF, et al.Survival in Cancer Patients Undergoing In-hospital Cardiopulmonary Resuscitation: A Meta-analysis[J]. Resuscitation,2006,71(2): 152-160. DOI:10.1016/j.resuscitation.2006.02.022. [5] Soares M, Depuydt PO,Salluh JI.Mechanical Ventilation in Cancer Patients: Clinical Characteristics and Outcomes[J]. Crit Care Clin,2010,26(1):41-58.DOI:10.1016/j.ccc.2009.09.005. [6] Mack JW, Weeks JC,Wright AA,et al.End-of-life Discussions, Goal Attainment, and Distress at the End of Life: Predictors and Outcomes of Receipt of Care Consistent with Preferences[J]. J Clin Oncol,2010,28(7):1203-1208. DOI:10.1200/JCO.2009.25.4672. [7] Barnato AE,Chang CH,Farrell MH,et al.Is Survival Better at Hospitals with Higher “End-of-life” Treatment Intensity?[J]. Med Care,2010,48(2):125-132.DOI:10.1097/MLR.0b013e3181c161e4. [8] Wright AA,Zhang B,Ray A,et al.Associations Between End-of-life Discussions,Patient Mental Health,Medical Care Near Death, and Caregiver Bereavement Adjustment[J]. JAMA,2008,300(14):1665-1673. DOI:10.1001/jama.300.14.1665. [9] Nicholas LH, Langa KM,Iwashyna TJ,et al.Regional Variation in the Association Between Advance Directives and End-of-life Medicare Expenditures[J]. JAMA,2011,306(13): 1447-1453. DOI:10.1001/jama.2011.1410. [10] Niederman MS, Berger JT.The Delivery of Futile Care Is Harmful to Other Patients[J]. Crit Care Med, 2010,38(10 suppl):518-522. DOI:10.1097/CCM.0b013e3181f1cba5. [11] Wendler D,Rid A.Systematic Review: The Effect on Surrogates of Making Treatment Decisions for Others[J]. Ann Intern Med,2011, 154(5):336-346.DOI:10.7326/0003-4819-154-5-201103010-00008. [12] Azoulay E,Pochard F,Kentish-Barnes N,et al.Risk of Post-traumatic Stress Symptoms in Family Members of Intensive Care Unit Patients[J]. Am J Respir Crit Care Med, 2005,171(9):987-994. DOI:10.1164/rccm.200409-1295OC. [13] Gries CJ,Engelberg RA,Kross EK,et al.Predictors of Symptoms of Posttraumatic Stress and Depression in Family Members after Patient Death in the ICU[J]. Chest, 2010,137(2):280-287. DOI:10.1378/chest.09-1291. [14] 周雯,毛靖,闻曲,等. 晚期肿瘤患者及家属对预先指示态度的一致性研究[J]. 中华护理杂志,2018, 53(1):27-32. DOI:10.3761/j.issn.0254-1769.2018.01.005. [15] 周雯,毛靖,闻曲,等. 肿瘤患者预前指示现况及影响因素调查[J]. 护理学杂志,2016,31(24):26-30. DOI:10.3870/j.issn.1001-4152.2016.24.026. [16] Lee JC,Chen PP,Yeo JK,et al.Hong Kong Chinese Teachers’Attitudes towards Life-sustaining Treatment in the Dying Patients[J].Hong Kong Med J,2003,9(3):186-191. DOI:10.1007/10757285_40. [17] Chung RY,Wong EL,Kiang N,et al.Knowledge, Attitudes, and Preferences of Advance Decisions, End-of-Life Care, and Place of Care and Death in Hong Kong. A Population-Based Telephone Survey of 1067 Adults[J]. J Am Med Dir Assoc,2017,18(4):367. DOI:10.1016/j.jamda.2016.12.066. [18] Aida J,Kuriyama S,Ohmori-Matsuda K,et al.The Association Between Neighborhood Social Capital and Self-reported Dentate Status in Elderly Japanese - The Ohsaki Cohort 2006 Study[J]. Community Dent Oral Epidemiol,2011,39(3):239-249. DOI:10.1111/j.1600-0528.2010.00590.x. [19] Tan WS, Bajpai R, Ho AHY, et al.Retrospective Cohort Analysis of Real-life Decisions about End-of-life Care Preferences in a Southeast Asian Country[J]. BMJ Open,2019,9(2):e24662. DOI:10.1136/bmjopen-2018-024662. [20] Chu LW, Luk JK,Hui E,et al.Advance Directive and End-of-Life Care Preferences Among Chinese Nursing Home Residents in Hong Kong[J]. J Am Med Dir Assoc,2011,12(2):143-152. DOI:10.1016/j.jamda.2010.08.015. [21] Kim J,An M,Heo S,et al.Attitudes toward Advance Directives and Prognosis in Patients with Heart Failure: A Pilot Study[J]. Korean J Intern Med,2020,35(1):109-118. DOI:10.3904/kjim.2018.158. [22] Yan Y, Demertzi A, Xia Y,et al.Ethics of Life-sustaining Treatment in Locked-in Syndrome: A Chinese Survey[J]. Ann Phys Rehabil Med,2019.DOI:10.1016/j.rehab.2019.09.011. [23] 钱湘云,谢幸尔,王园园,等. 慢性乙型肝炎患者社会支持及疾病家庭负担的相关性分析[J]. 中华现代护理杂志,2018,24(1):71-75.DOI:10.3760/cma.j.issn.1674-2907.2018.01.015. [24] 宁晓东,万恩桂,杨春,等. 尊严疗法及人生回顾干预对晚期住院癌症患者尊严及心理状况的影响[J]. 护理学报,2018,25(13):64-68. DOI:10.16460/j.issn1008-9969.2018.13.064. [25] Bowman KW,Singer PA.Chinese Seniors’ Perspectives on End-of-life Decisions[J]. Soc Sci Med,2001,53(4):455-464. DOI:10.1016/s0277-9536(00)00348-8. [26] Liu LN,Chen CH,Liu TW,et al.Preferences for Aggressive End-of-life Care and Their Determinants Among Taiwanese Terminally Ill Cancer Patients[J].Cancer Nurs,2015,38(3):E9-E18.DOI:10.1097/NCC.0000000000000155. [27] Scholten G,Bourguignon S,Delanote A,et al.Advance Directive: Does the GP Know and Address what the Patient Wants? Advance Directive in Primary Care[J]. BMC Med Ethics,2018,19(1):58. DOI:10.1186/s12910-018-0305-2. [28] Ballou JH,Dewey EN,Zonies DH.Elderly Patients Presenting to a Level I Trauma Center with a POLST Form: A Propensity-matched Analysis[J]. J Trauma Acute Care Surg,2019,87(1):153-160.DOI:10.1097/TA.0000000000002321. [29] 唐楠,赵延慧,张宏晨,等. 221名不孕症女患者治疗期间希望水平现状及影响因素分析[J]. 护理学报,2018,25(6): 28-32. DOI:10.16460/j.issn1008-9969.2018.06.028. [30] Walbert T.Maintaining Quality of Life Near the End of Life: Hospice in Neuro-oncology[J]. Neuro Oncol,2018,20(4):439-440. DOI:10.1093/neuonc/nox236. [31] 刘迎春,齐红. 癌症患者对预先指示认知状况的调查研究[J]. 新乡医学院学报,2014,31(9):763-765. DOI:10.7683/xxyxyxb.2014.09.029. [32] 张敏,王清,李红丽. 急性脑卒中患者心理弹性现况及其影响因素研究[J]. 护理学报,2018,25(9):75-78. DOI:10.16460/j.issn1008-9969.2018.09.075. [33] 张彤,严勤,姚有华. 患绝症临终病人的心理护理[J]. 中国全科医学,2007,10(9):716-717. DOI:10.3969/j.issn.1007-9572.2007.09.012. |
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