【作者】 李娜；

【导师】 袁玲；

【作者基本信息】 南京大学 ， 护理（专业学位）， 2021， 硕士

【摘要】 [目的]本研究拟构建科学、本土化的晚期癌症患者安宁疗护服务对象筛查清单,及时识别需要接受安宁疗护服务的晚期癌症患者的特征,为临床医护人员安宁疗护实践工作提供依据。[方法]1.通过文献检索,采用主题词与自由词结合的方式系统性地检索有关晚期癌症患者接受安宁疗护服务的指征的临床指南、系统评价、原始研究等,并对文献进行阅读和评价提取相关条目,形成晚期癌症患者安宁疗护服务对象筛查清单的条目池。2.采用焦点团体访谈法对获得的条目进行深入讨论与分析,基于我国癌症患者安宁疗护服务的实际临床情况增加或删减条目,拟定晚期癌症患者安宁疗护服务对象筛查清单条目内容。3.采用德尔菲专家函询法,遴选国内不同省份15名专家进行函询,统计分析函询结果形成晚期癌症患者安宁疗护服务对象筛查清单。[结果]1.基于循证检索和文献分析完成课题的背景研究,以Glaser和Strauss两位学者提出的临终轨迹概念为理论依据,结合肿瘤患者安宁疗护的指南和相关文献,提取和整理识别晚期癌症患者接受安宁疗护服务的指征,形成晚期癌症患者安宁疗护服务对象筛查清单条目池。结合焦点团体访谈法在文献检索所得结果的基础上,结合我国临床的实际情况对所提取的晚期癌症患者接受安宁疗护服务筛查清单的条目进行深入讨论,制定晚期癌症患者安宁疗护服务对象筛查清单条目的具体内容从而形成德尔菲专家函询问卷。2.经过两轮的专家函询,明确了晚期癌症患者安宁疗护服务对象筛查清单的条目和内容包括“疾病诊断”、“患者/家属的需求”、“生理指征”和“心理指征”4个条目,其中“疾病诊断”中包括新增远处转移病灶或局部进展和晚期癌症,针对病因的治疗效果减弱或无效两项内容;“患者/家属的需求”包括患者/家属要求接受安宁疗护服务;“生理指征”包括出现癌症厌食-恶病质综合征(CACS)、活动状态差,ECOG≥3或者KPS≤50、出现难以控制的症状、过去6个月体重下降>10%,血清蛋白<25g/l、存在2个或2个以上慢性合并症5项内容;“心理指征”包括患者中度至重度症状强度的心理痛苦一项内容。(1)共纳入的15位专家,两轮函询的问卷回收率均为100%,专家的积极性高。(2)权威系数Cr分别为0.88、0.89,均>0.7,函询结果可靠。(3)本研究中第一轮函询后各指征的重要性评价其变异系数均波动在0.05-0.42之间,第二轮函询后各指征的重要性评价其变异系数均波动在0.1-0.22之间,表明专家协调性较好。第一轮专家函询中条目和内容指标重要性评价的协调系数分别是0.152和0.165,第二轮专家函询中条目和内容指标重要性评价的协调系数分别是0.162和0.199,两轮专家函询的协调系数检验均具有统计意义(P<0.05)。[结论]晚期癌症患者安宁疗护服务对象筛查清单条目和内容的专家的积极性、权威程度和重要性赋值的意见集中程度较好,清单的构建为临床医护人员的安宁疗护实践提供依据。更多还原

【Abstract】 [Objective]This study intends to construct a scientific and localized screening checklist for for palliative care patients with advanced cancer to identify the characteristics of advanced cancer patients in need of palliative care in a timely manner and to provide a basis for the palliative care service of clinical health care workers.[Methods]1.Through literature search,clinical guidelines,systematic evaluations,and original studies on the indications for palliative care patients with advanced cancer were systematically searched using a combination of mesh terms and text words,and relevant entries were extracted by reading and evaluating the literature to form a pool of entries for the screening checklist for palliative care patients with advanced cancer2.Focus group interviews were used to discuss and analyze the obtained entries in depth,add or delete entries based on the actual clinical situation of palliative care for patients with advanced cancer in China,and develop the content of the entries of the screening checklist for palliative care patients with advanced cancer3.Using the Delphi method,15 experts from different provinces in China were selected for consultation,and the results were statistically analyzed to form a screening checklist for palliative care patients with advanced cancer.[Results]1.Based on the evidence-based search and literature analysis,we completed the background research of the project,and used the concept of end-of-life trajectory proposed by Glaser and Strauss as the theoretical basis,combined with the guidelines of palliative care for oncology patients and related literature,extracted and organized the indications for identifying palliative care services for patients with advanced cancer,and formed a pool of entries for the screening checklist for palliative care for patients with advanced cancer.Based on the results of the literature search and the actual clinical situation in China,the extracted items of the palliative care screening checklist for advanced cancer patients were discussed in depth,and the specific contents of the palliative care screening checklist for advanced cancer patients were developed based on the focus group interview method to form the Delphi expert correspondence questionnaire.2.After two rounds of expert consultation,the items and content of the Palliative care Screening Checklist for Advanced Cancer Patients were clarified to include"disease diagnosis","patient/family needs","physical indications" and "psychological indications"."Among them,"disease diagnosis" includes the addition of distant metastatic lesions or local progression and advanced cancer,and the diminished or ineffective treatment of the cause of the disease.The "patient/family needs" included patient/family request for hospice services;"physical indications" included the presence of cancer anorexia-cachexia syndrome(CACS),poor activity status with ECOG ≥ 3 or KPS ≤ 50,the presence of uncontrollable symptoms,and the presence of a number of other symptoms in the past 6 months.The physical indications included the presence of anorexia-cachexia syndrome(CACS),poor activity status,ECOG ≥3 or KPS ≤50,difficult-to-control symptoms,weight loss >10% in the past 6months,serum protein <25g/l,and the presence of 2 or more chronic comorbidities;the psychological indications included psychological distress of moderate to severe symptom intensity in patients/families.(1)A total of 15 experts were included,and the questionnaire return rate of both rounds of correspondence was 100%,which showed high motivation of experts.(2)The authority coefficients Cr were 0.88 and0.89,respectively,both >0.7,and the results of the correspondence inquiries were reliable.(3)In this study,the coefficients of variation of the importance evaluations of each index fluctuated between 0.05 and 0.42 after the first round of consultation,and the coefficients of variation of the importance evaluations of each index fluctuated between 0.1 and 0.22 after the second round of consultation,indicating that the experts’ coordination was good.The coefficients of coordination for the importance evaluation of items and content indicators in the first round of expert consultation were 0.152 and 0.165,respectively,and the coefficients of coordination for the importance evaluation of items and content indicators in the second round of expert consultation were 0.162 and 0.199,respectively,and the tests of coordination coefficients in both rounds of expert consultation were statistically significant(P <0.05).[Conclusions]The positive,authoritative,and importance-assigned opinion of experts on the entries and content of the screening checklist for palliative care patients with advanced cancer is well focused to provide a basis for hospice practice by clinical providers.更多还原