体外循环心脏手术患者术前对预先指示认知情况调查
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摘要
目的了解体外循环下心脏手术患者术前对预先指示认知情况并分析其影响因素。方法方便抽取体外循环心脏手术患者172例,采用一般人口学资料问卷及预先指示认知问卷调查患者。结果 41.3%的患者听说过预先指示,60.5%的患者愿意接受预先指示。Logistic回归分析显示,影响患者是否接受预先指示的独立因素有:文化程度、医疗决策主体、医疗决策中谁的意见最重要、病情难以逆转或疾病晚期是否放弃治疗、生存质量重要还是生存时间重要、是否听说过预先指示、是否听说过生前预嘱、是否听说过预立医疗代理人(均P<0.01)。结论体外循环心脏手术患者对预先指示的了解较少,但对预先指示持支持态度,提高患者对预先指示的认知水平有助于提高患者对预先指示的接受程度。
Objective to investigate the knowledge of advance directives in patients to receive cardiopulmonary bypass cardiac surgery under extracorporeal circulation and to analyze the influencing factors.Methods Totally, 172 patients to receive cardiopulmonary bypass cardiac surgery under extracorporeal circulation were involved in the study through convenience sampling and completed the general demographic questionnaire and the knowledge of advance directives questionnaire.Results Among the participants, 41.4% had heard of advance directives, and 60.5% were willing to accept the advance directives. According to the results of binary logistic regression analysis, the following independent factors influenced patients′ acceptance of advance directives:educational levels, the persons who made medical decision, the person who made the most weighted decision, giving up treatment due to irreversible disease conditions or advanced stage diseases, the cognition whether quality of life or length of survival matters, whether or not to have heard of advance directives, whether or not to have heard of living wills, whether or not to have heard of durable power of attorney(P<0.01 for all).Conclusion Patients to receive cardiopulmonary bypass cardiac surgery under extracorporeal circulation had poor knowledge of advance directives, but they were supportive of advance directives. Improving patients′ cognitive level of advance directives will help to promote their acceptance of advance directives.
Objective to investigate the knowledge of advance directives in patients to receive cardiopulmonary bypass cardiac surgery under extracorporeal circulation and to analyze the influencing factors.Methods Totally, 172 patients to receive cardiopulmonary bypass cardiac surgery under extracorporeal circulation were involved in the study through convenience sampling and completed the general demographic questionnaire and the knowledge of advance directives questionnaire.Results Among the participants, 41.4% had heard of advance directives, and 60.5% were willing to accept the advance directives. According to the results of binary logistic regression analysis, the following independent factors influenced patients′ acceptance of advance directives:educational levels, the persons who made medical decision, the person who made the most weighted decision, giving up treatment due to irreversible disease conditions or advanced stage diseases, the cognition whether quality of life or length of survival matters, whether or not to have heard of advance directives, whether or not to have heard of living wills, whether or not to have heard of durable power of attorney(P<0.01 for all).Conclusion Patients to receive cardiopulmonary bypass cardiac surgery under extracorporeal circulation had poor knowledge of advance directives, but they were supportive of advance directives. Improving patients′ cognitive level of advance directives will help to promote their acceptance of advance directives.
引文
[1] 赵举,黑飞龙.2015中国心脏外科和体外循环数据白皮书[J].中国体外循环杂志,2016,14(3):130-132.
[2] American Academy of Family Physicians.Information from your family doctor:advance directives[J].Am Fam Physician,2005,72(7):1270.
[3] Bedell S E,Delbanco T L,Cook E F,et al.Survival after cardiopulmonary resuscitation in the hospital[J].N Engl J Med,1983,309(10):569-576.
[4] Ghusn H F,Teasdale T A,Boyer K.Characteristics of patients receiving or foregoing resuscitation at the time of cardiopulmonary arrest[J].J Am Geriatr Soc,1997,45(9):1118-1122.
[5] Rabkin M T,Gillerman G,Rice N R.Orders not to resuscitate[J].N Engl J Med,1976,295(7):364-366.
[6] 孙也龙.台湾预立医疗决定制度研究——以“病人自主权利法”的通过为契机[J].台湾研究集刊,2017(4):44-53.
[7] 张巧滔,郭燕,徐晓霞.医护人员对预先指示的态度及其影响因素分析[J].中国护理管理,2014,14(8):818-822.
[8] 周雯,毛靖,闻曲.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):28-32.
[9] 倪平,曾轶英,夏莹,等.武汉市养老院老年人预前指示现况及影响因素调查[J].护理学杂志,2014,29(3):15-18.
[10] 贺春艳,郭燕,袁彬彬.河南农村老年人预先指示的态度及影响因素分析[J].中华现代护理杂志,2015,21(27):3250-3253.
[11] 张凤佩.癌症患者对预先指示认知状况的调查研究[D].太原:山西医科大学,2012.
[12] 周雯,毛靖,闻曲.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.
[13] 郑连雪.晚期胃癌患者生活质量及其影响因素的分析[D].太原:山西医科大学,2009.
[14] Muni S,Engelberg R A,Treece P D,et al.The influence of race/ethnicity and the ICU socioeconomic status on end-of-life care in the ICU[J].Chest,2011,139(5):1025-1033.
[15] Antollin A,Sanchez M,Miro O.Temporal trend in understanding of and attitudes to advance directives in patients with chronic diseases[J].Gac Sanit,2011,25(5):412-418.
[16] Akabayashi A,Slingsby B T,Kai I.Perspectives on advance directives in Japanese society:a population-based questionnaire survey[J].BMC Med Ethics,2003,4:E5.
[17] Katia P,Jesu S H,Ma Jose H.Study of the factors influencing the preparation of advance directives[J] .Arch Gerontol Geriatr,2014,58(1):20-24.
[18] Hinders D.Advance directives:limitations to completion[J].Am J Hosp Palliat Care,2012,29(4):286-289.
[2] American Academy of Family Physicians.Information from your family doctor:advance directives[J].Am Fam Physician,2005,72(7):1270.
[3] Bedell S E,Delbanco T L,Cook E F,et al.Survival after cardiopulmonary resuscitation in the hospital[J].N Engl J Med,1983,309(10):569-576.
[4] Ghusn H F,Teasdale T A,Boyer K.Characteristics of patients receiving or foregoing resuscitation at the time of cardiopulmonary arrest[J].J Am Geriatr Soc,1997,45(9):1118-1122.
[5] Rabkin M T,Gillerman G,Rice N R.Orders not to resuscitate[J].N Engl J Med,1976,295(7):364-366.
[6] 孙也龙.台湾预立医疗决定制度研究——以“病人自主权利法”的通过为契机[J].台湾研究集刊,2017(4):44-53.
[7] 张巧滔,郭燕,徐晓霞.医护人员对预先指示的态度及其影响因素分析[J].中国护理管理,2014,14(8):818-822.
[8] 周雯,毛靖,闻曲.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):28-32.
[9] 倪平,曾轶英,夏莹,等.武汉市养老院老年人预前指示现况及影响因素调查[J].护理学杂志,2014,29(3):15-18.
[10] 贺春艳,郭燕,袁彬彬.河南农村老年人预先指示的态度及影响因素分析[J].中华现代护理杂志,2015,21(27):3250-3253.
[11] 张凤佩.癌症患者对预先指示认知状况的调查研究[D].太原:山西医科大学,2012.
[12] 周雯,毛靖,闻曲.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.
[13] 郑连雪.晚期胃癌患者生活质量及其影响因素的分析[D].太原:山西医科大学,2009.
[14] Muni S,Engelberg R A,Treece P D,et al.The influence of race/ethnicity and the ICU socioeconomic status on end-of-life care in the ICU[J].Chest,2011,139(5):1025-1033.
[15] Antollin A,Sanchez M,Miro O.Temporal trend in understanding of and attitudes to advance directives in patients with chronic diseases[J].Gac Sanit,2011,25(5):412-418.
[16] Akabayashi A,Slingsby B T,Kai I.Perspectives on advance directives in Japanese society:a population-based questionnaire survey[J].BMC Med Ethics,2003,4:E5.
[17] Katia P,Jesu S H,Ma Jose H.Study of the factors influencing the preparation of advance directives[J] .Arch Gerontol Geriatr,2014,58(1):20-24.
[18] Hinders D.Advance directives:limitations to completion[J].Am J Hosp Palliat Care,2012,29(4):286-289.