江苏某高校医学研究生生前预嘱认知现状研究
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摘要
目的探讨高校医学类研究生生前预嘱(advance directives,ADs)认知与接受度现状,并分析其影响因素。方法采用问卷星在线问卷调查法,对江苏大学200名医学类研究生进行调查。结果共回收有效问卷200份(100%),男女生比例接近0.3∶1。认知现状调查中79%的医学研究生不了解ADs;44%的医学研究生很支持ADs作为政策推广;87%的医学研究生接受填写ADs;58%目睹过患者临终;90%的医学研究生从未接触过ADs的教育或学习;10%的医学研究生通过课堂学习接触ADs;15%的医学研究生并不愿意在课堂中谈论死亡;54%的医学研究生愿意推荐周围人使用ADs;52%的医学研究生认为ADs应在年老体健时填写。医学研究生是否接触过ADs教育或学习、获知ADs相关信息的途径及是否愿意推荐周围人使用ADs与医学研究生ADs认知度之间存在统计学差异(P<0.05);医学研究生是否接触过ADs教育或学习、是否愿意谈论死亡、是否愿意推荐周围人使用ADs、对ADs的推广支持度及是否认可临终生命支持系统与医学研究生ADs接受度之间存在统计学差异(P<0.05)。结论当前医学研究生ADs认知度低、接受度高、推广支持度一般。医学研究生在读期间ADs的教育与学习严重不足,教育途径较单一,亟需完善;医学研究生对临终的态度、对生命支持治疗的选择等是影响医学研究生ADs医疗决策选择的重要因素,建议高校、医院在研究生培养时纳入ADs课程内容,为医学研究生未来临床工作做好角色准备,以正确引导患者做出理智选择。
Objective The objective of this study was to explore medical graduate students' knowledge and acceptance of advance directives(ADs), and to analyze the influencing factors. Methods A questionnaire survey was conducted among 200 medical graduate students from Jiangsu University by using the online questionnaire survey Wenjuanxing. Results A total of 200 valid questionnaires(100%) were collected, and the ratio of boys to girls was close to 0.3 ∶ 1. In the survey, 79% of medical graduate students did not know ADs; 44% of medical graduate students supported ADs as a policy promotion; 87% of medical graduate students accepted to fill ADs; 58% had witnessed the death of patients; 90% of medical graduate students had never contacted the education or learning of ADs; 10% of medical graduate students contacted the ADs through classroom learning; 15% of medical graduate students were reluctant to talk about death in class; 54% of medical graduate students were willing to recommend ADs to people around them; 52% of medical graduates believed that ADs should be filled in when they were old and healthy. There were statistical differences between medical graduate students' exposure to education or learning of ADs, access to information related to ADs, their willingness to recommend the use of ADs to their surroundings and medical graduate students' cognition of ADs(P<0.05). There were statistical differences between medical graduate students' exposure to the education or learning of ADs, willingness to talk about death, willingness to recommend the use of ADs to people around them, support for the promotion of ADs, acceptance of end-of-life support system and medical graduate students' acceptance of ADs(P<0.05). Conclusions At present, medical graduate students have low recognition, high acceptance, and general promotion support of ADs. The education and learning of medical graduate students' ADs during their study period are seriously inadequate, and the educational approach is relatively simple, which needs to be improved urgently; the attitude of medical graduate students towards the end of life and the choice of life support treatment are important factors affecting the choice of medical decision-making for medical graduate students' ADs advice. It is recommended that universities and hospitals incorporate ADs curriculum into postgraduate training so as to prepare for the role of medical graduate students in future clinical work, and so as to correctly guide patients to make rational choices.
Objective The objective of this study was to explore medical graduate students' knowledge and acceptance of advance directives(ADs), and to analyze the influencing factors. Methods A questionnaire survey was conducted among 200 medical graduate students from Jiangsu University by using the online questionnaire survey Wenjuanxing. Results A total of 200 valid questionnaires(100%) were collected, and the ratio of boys to girls was close to 0.3 ∶ 1. In the survey, 79% of medical graduate students did not know ADs; 44% of medical graduate students supported ADs as a policy promotion; 87% of medical graduate students accepted to fill ADs; 58% had witnessed the death of patients; 90% of medical graduate students had never contacted the education or learning of ADs; 10% of medical graduate students contacted the ADs through classroom learning; 15% of medical graduate students were reluctant to talk about death in class; 54% of medical graduate students were willing to recommend ADs to people around them; 52% of medical graduates believed that ADs should be filled in when they were old and healthy. There were statistical differences between medical graduate students' exposure to education or learning of ADs, access to information related to ADs, their willingness to recommend the use of ADs to their surroundings and medical graduate students' cognition of ADs(P<0.05). There were statistical differences between medical graduate students' exposure to the education or learning of ADs, willingness to talk about death, willingness to recommend the use of ADs to people around them, support for the promotion of ADs, acceptance of end-of-life support system and medical graduate students' acceptance of ADs(P<0.05). Conclusions At present, medical graduate students have low recognition, high acceptance, and general promotion support of ADs. The education and learning of medical graduate students' ADs during their study period are seriously inadequate, and the educational approach is relatively simple, which needs to be improved urgently; the attitude of medical graduate students towards the end of life and the choice of life support treatment are important factors affecting the choice of medical decision-making for medical graduate students' ADs advice. It is recommended that universities and hospitals incorporate ADs curriculum into postgraduate training so as to prepare for the role of medical graduate students in future clinical work, and so as to correctly guide patients to make rational choices.
引文
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[2]武燕燕.120名老年科护士对生前预嘱的认知现状调查[J].护理学报,2017,24(2):45-48.DOI:10.16460/j.issn1008-9969.2017.02.045.
[3]代至敏,许琢,左小波.286名老年慢病住院患者对生前预嘱态度及影响因素的调查分析[J].现代医学与健康研究,2018,2(6):160.DOI:cnki:sun:xyjd.0.2018-06-133.
[4]孙佳,丁群华,郭振江,等.郑州市医务人员对“生前预嘱”认知及认同情况的调查分析[J].河南医学研究,2018,27(8):1345-1347.DOI:10.3969/j.issn.1004-437X.2018.08.00.
[5]Guda S,Sofie B,Anthonty D,et al.Advance directive:does the GP know and address what the patient wants?Advancedirective in primary care[J].BMC Med Ethics,2018,19(1):58.DOI:10.1186/s 12910-018-0305-2.
[6]缪佳芮,陈柳柳,张江辉,等.晚期癌症患者预立医疗照护计划质性研究进展[J].医学与哲学,2018,39(2):61-64.DOI:10.12014/j.issn.1002-0772.2018.01b.18.
[7]韩素红,李厚伸,夏丽娜,等.预立医疗照护计划的实践与研究进展[J].中国护理管理,2018,18(3):298-302.DOI:10.3969/j.issn.1672-1756.2018.03.003.
[8]李宇芳,邹剑莹,骆坚,等.医护患对实施预立医疗照护计划的态度及影响因素调查[J].护理学报,2014(16):21-24.
[9]Silva E,Neves M,Silva D.Nurses'perceptions of advance directives[J].Aten Primaria,2014,46(Suppl 5):145-149.DOI:10.1016/S0212-6567(14)70082-4.
[10]王丽英.晚期肿瘤患者预立医疗照护计划的探索性研究[D].复旦大学,2012.
[11]王毅欣,王秀敏,焦丽,等.晚期肿瘤患者对生前预嘱及临终关怀的认知及影响因素研究[J].医学与哲学,2019,40(5):30-34.
[12]谈学灵,赵宝玉,曹晓容,等.医护人员对预先指示的认知及影响因素研究[J].医学与哲学,2017,38(12B):88-92.DOI:10.12014/j.issn.1002-0772.2017.12b.26.
[13]张丹丹,李虹,赵璠,等.社区医护人员预立医疗照护计划知信行的调查[J].护理学杂志,2019,34(1):77-102.DOI:10.3870/j.issn.1001-4152.2019.01.077.
[14]Blanca M.Nurses preparation for advanced directives:An integrative review[J].J Prof Nurs,2018,34(5):369-377.DOI:10.101 6/j.profnurs.2018.07.001.
[15]George T P,DeCristofaro C,Murphy P F,et al. Knowledge,attitudes,and experience with advance directives among prelicensure nursing students[J].J Nurs Educ,2018,57(1):35-39.DOI:10.3928/01484834-20180102-07.
[16]Lydon E,Peters C,Aksenov L,et al.An interdisciplinary approach to teaching end-of-life communication[J].Med Educ,2018,52(11):1205-1206.DOI:10.1111/medu.13717.
[17]Solis G R,Mancera B M,Shen M J.Strategies used to facilitate the discussion of advance care planning with older adults in primary care settings:A literature review[J].J Am Assoc Nurse Pract,2018,30(5):270-279.DOI:10.1097/JXX.0000000000000025.
[18]唐绍军,姜洁,曾利辉.恶性肿瘤患者病情告知时的伦理冲突与应对策略[J].中国医学伦理学,2017,30(10):1259-1262.