对医护人员晚期老年痴呆患者预立医疗照护计划的态度调查

摘要

目的 调查医护人员对晚期老年痴呆症患者实施预立医疗照护计划的态度及相关影响因素.方法 2014年12月采用一般资料调查表、病情告知态度及行为问卷、预立医疗照护计划态度及行为问卷对济南市3家三级甲等医院神经内科医护人员63人进行调查.结果 76.2%(48/63)的医护人员支持对老年痴呆症患者预先设立医疗照护计划的行为,63名医护人员均认为知道患者的生命意愿是非常重要的;88.9%愿意在具备预立医疗照护条件下,协助患者在认知清楚或痴呆早期时预先设立生命意愿;63.4%希望在具备预立医疗照护条件下,协助患者将自己的治疗权委托给其亲人.但是其中约70.0%的医护人员对于让痴呆早期患者预立生命意愿的行为存在多种顾虑.77.8%的医护人员认为晚期老年痴呆症患者非常需要实施姑息照护,但是涉及具体的姑息照护措施时,约80.0%的医护人员还是表现出消极的态度.95.2%的医护人员认为患者的医疗决策通常是由患者、家属及医生三者讨论后决定的.单因素分析结果 显示,不同职业、婚姻状况、宗教信仰、丧亲经历、是否接受过姑息培训特征的医护人员对AD实施态度差异有统计学意义(P<0.05).Logistic回归分析显示,医护人员AD实施相关态度及行为的影响因素为职业(P<0.05).结论 医护人员对设立预立医疗照护计划表现出积极认可和支持的态度,但在具体实施方面仍有很多顾虑.%Objective To investigate the attitude of medical staff on advance directives and influential factors. Methods A total of 63 medical staff members from 3 third-grade class-A hospitals were investigated with general information questionnaire, informing attitude and behavior questionnaire, attitude and behavior of advance directives questionnaire in December 2014. Results 76. 2%(48/63) of medical staff members support the behavior of advance directives for senile dementia patients. 63 medical staff members thought that it was very important to learn about patients' life intention. At the same time, under the condition of advance directives, 88. 9% of medical staff members were medical staff willing to helping patients to set up life intention with clear cognition or early-stage dementia;63. 4% of medical staff members wanted to help patients entrust their treatment authority to their loved ones. However, 70. 0% of medical staff members still were worried about the behavior of pre-established life intention for senile dementia patients. Though 77. 8% of medical staff thought that it was a need to use palliative care, 80. 0% still shown a negative attitude when it came to specific palliative care measures. 95. 2% of medical staff thought that medical decisions should be decided by patients, family members and doctors. Single factor analysis of variances showed that different occupation, marriage status, religious belief, bereavement experience, whether to accept the training of palliative care caused a significant difference in attitude of conduction (P<0. 05). Logistic regression analysis showed that the influencing factor of attitude and behavior of advance directives was occupation (P<0. 05). Conclusions Medical staff members show positive attitude with recognition and support on advance directives, but they still are worried about specific implementation.