晚期癌症病人需求评估体系构建及临床初步应用研究
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摘要
目的：通过“晚期癌症病人需求评估体系”的构建，为临床护理人员提供一个评估晚期癌症住院病人需求的测量工具，进一步提高临床护理人员评估晚期癌症病人需求的能力。
方法：
1．“晚期癌症病人需求评估体系”的构建 主要采用以下方法和步骤：
(1)收集指标 采用文献调研法，提出指标体系初步架构，咨询长期从事恶性肿瘤治疗、护理的医生和护士各2人，晚期癌症住院患者3人，恶性肿瘤恢复期患者3人的意见，据此对初步架构进行修改，之后形成新的指标体系架构。
(2)筛选指标 采用特尔斐法，邀请36名专家进行2轮意见咨询，与4名晚期癌症病人进行半结构式访谈征询意见，对20例晚期癌症病人预调查等，通过多种方法筛选评估体系指标。
2．“晚期癌症病人需求评估体系”临床初步应用 采用本研究所构建的问卷，调查2所医院96例晚期癌症住院病人的生理、心理、社会和精神等方面的需求现况及影响因素，同时基于实测数据对该评估体系的科学性做出评价。
结果：
第四军医大学硕士学位论文
1.构建了“晚期癌症病人需求评估体系”。该体系涵盖生理、
心理、精神和社会4个I级指标，12个H级指标，41个m级指标。
采用4级评分法，全部为正向评分，得分越高，需求程度越高。
需求程度分高、中、低三级。
2.晚期癌症病人需求评估体系有较好的科学性。调查问卷回
收率为98.0%，重复测量回收率87.5%，完成率为97.96%，说明
本调查问卷可行性好。重测信度，总分Pearson相关系数为0.827。
四个领域相关系数分别为生理需求0.823，心理需求0.636，精神
需求0.796，社会需求0.875。同质性信度，四个领域的克伦巴赫
系数a(Cronbaeh’5 a Coeffieient)分别为:生理需求0.7219，心理需
求0.6412，精神需求0.7502，社会需求0.8275。结构效度，用主
成分分析加因子分析，抽取特征值>1的12个主成分，累计贡献率
达71.81%，经最大方差正交旋转，得到载荷较大的12个因子，这
12个因子基本涵盖了生理、心理、精神、社会四个方面，说明有
较好的结构效度。
3.96例晚期癌症住院病人总体需求程度以中、高度为主。高
度需求占37.5%，中度需求占39.6%，低度需求占22.9%。晚期癌
症病人在心理、精神、社会三个方面需求程度较生理方面需求程
度高，高需求分别占54.2%、50.2%和62.5%和10.4%。
从各指标得分均数排序情况看，排在第1一17位项目均为高度
需求，排在第18一33位的项目为中度需求，排在第34一41位的项目
为低度需求。
排在前5位的需求依次是需要家人关爱、希望感到对家庭有
用、希望了解检查结果、希望家人陪伴和希望了解治疗效果。
经相关分析发现，自理能力与生理需求呈负相关;住院次数
与心理需求程度高呈正相关。经t检验(LSD)和单因素方差分析
发现，性别、年龄、文化程度、宗教等因素对需求程度影响无差
异。经t检验，在a=0.05时，已婚与离异两组之间、住院次数1
第四军医大学硕士学位论文
次与3次两组之间、完全自理与完全不能自理之间有差异。
结论:
构建了“晚期癌症病人需求评估体系”，经临床初步验证有较
好的信度、效度和可行性，可以用于晚期癌症住院病人需求评估。
Aim: An instrument of assessing the terminally ill cancer patient' needs was supply for clinical nurses by developing index system of evaluation of the terminally ill cancer patient' needs to improve theirs ability of evaluating the terminally ill cancer patient' needs. Methods: 1. Item generation : 甌he items of evaluation system were collected by literature search, seeking advices from two doctors, two nurses, three terminally ill cancer inpatients and three cancer patients in convalescent period. ㏕he items of evaluation system were elected with Delphi method by two experts panels, semi-structured interviewing four terminal ill cancer patients and twenty pre-interview terminal ill cancer patients.
2. Clinical primary application of the index system of evaluation of the terminally ill cancer patient' needs. Prevalence survey of physiological, psychological, social needs and spirit support of 96
terminally ill cancer patients was conducted in 2 hospitals in xi'an. Validity, reliability and feasibility of the index system of evaluation of the terminally ill cancer patients' need were estimated by statistics according to data. Results:
1. The evaluating system of the terminally ill cancer patients' needs was built which consists of 3 grade indexs, there are 4 items in grade 1, 12 items in grade 2, 41 items in grade 3.We use 4 ranks to score them. High degree of needs that has 3 grades (high, middle, low).
2. The index system of evaluation of the terminally ill cancer patients' needs have satisfactory validity and reliability. The questionnaire's response rate of was 98%, test-retest was 87.5% and completion rate was 97.96%. These indicated this questionnaire was feasible to use. Total Pearson's correlation coefficient was 0.827. Pearson's correlation coefficient of physiological, psychological, social and spiritual support was 0.823, 0.636, 0.796, and 0.875, respectively. It explained test-retest reliability. Cronbach's a Coefficient of physiological, psychological, social and spiritual support was 0.7219, 0.6412, 0.7502, and 0.8275, respectively. It represent inter-item consistency. 12 principal components with eigenvalue > 1 were extracted by principal component analysis and varimax orthogonal rotation methods. Its cumulative was 71.81%. These 12 principal components including physiological, psychological, social and spiritual support domains. It
indicated satisfactory construct -related validity. 3. The need degree of majority of 96 terminally ill cancer patients was middle or high degree. It consists of 37.4% high need degree, 39.6% middle need degree and 22.9% low need degree, respectively. Psychological, social and spiritual support for terminally ill cancer patients was high than physiological support for them. The rate of patients needs the high psychological, social, spiritual and physiological support were 54.2%, 50.2%, 62.5% and 10.4%, respectively.
The need degree of terminally ill cancer patients was ranked according to the mean of every item. From range 1 to range 17 were high need degree. These 5 items (from range 1 to range 5) were high need degree (the need for caring of family member; the need for contributing to family; the need for knowing inspection results; the need for companioning with family member; the need for knowing curative effect). These 15 items (from range 18 to range 33) were middle need degree. These 7 items (from range 34 to range 41) were low need degree.
According to t test and A one-way analysis of variance (ANOVA) test, sex, age, marriage, educational history and religion did not influence the need degree of terminally ill cancer patients. Self-care ability was negative correlation with physiological need (r=-0.371 , P =0.000) . The need degree was high when Self-care ability was low. When the patient was in hospital fist time, he need high psychological support. Conclusion: To develop index system of evaluation of the terminally
ill cancer patient' needs successfully. This system has satisfactory validity an
方法：
1．“晚期癌症病人需求评估体系”的构建 主要采用以下方法和步骤：
(1)收集指标 采用文献调研法，提出指标体系初步架构，咨询长期从事恶性肿瘤治疗、护理的医生和护士各2人，晚期癌症住院患者3人，恶性肿瘤恢复期患者3人的意见，据此对初步架构进行修改，之后形成新的指标体系架构。
(2)筛选指标 采用特尔斐法，邀请36名专家进行2轮意见咨询，与4名晚期癌症病人进行半结构式访谈征询意见，对20例晚期癌症病人预调查等，通过多种方法筛选评估体系指标。
2．“晚期癌症病人需求评估体系”临床初步应用 采用本研究所构建的问卷，调查2所医院96例晚期癌症住院病人的生理、心理、社会和精神等方面的需求现况及影响因素，同时基于实测数据对该评估体系的科学性做出评价。
结果：
第四军医大学硕士学位论文
1.构建了“晚期癌症病人需求评估体系”。该体系涵盖生理、
心理、精神和社会4个I级指标，12个H级指标，41个m级指标。
采用4级评分法，全部为正向评分，得分越高，需求程度越高。
需求程度分高、中、低三级。
2.晚期癌症病人需求评估体系有较好的科学性。调查问卷回
收率为98.0%，重复测量回收率87.5%，完成率为97.96%，说明
本调查问卷可行性好。重测信度，总分Pearson相关系数为0.827。
四个领域相关系数分别为生理需求0.823，心理需求0.636，精神
需求0.796，社会需求0.875。同质性信度，四个领域的克伦巴赫
系数a(Cronbaeh’5 a Coeffieient)分别为:生理需求0.7219，心理需
求0.6412，精神需求0.7502，社会需求0.8275。结构效度，用主
成分分析加因子分析，抽取特征值>1的12个主成分，累计贡献率
达71.81%，经最大方差正交旋转，得到载荷较大的12个因子，这
12个因子基本涵盖了生理、心理、精神、社会四个方面，说明有
较好的结构效度。
3.96例晚期癌症住院病人总体需求程度以中、高度为主。高
度需求占37.5%，中度需求占39.6%，低度需求占22.9%。晚期癌
症病人在心理、精神、社会三个方面需求程度较生理方面需求程
度高，高需求分别占54.2%、50.2%和62.5%和10.4%。
从各指标得分均数排序情况看，排在第1一17位项目均为高度
需求，排在第18一33位的项目为中度需求，排在第34一41位的项目
为低度需求。
排在前5位的需求依次是需要家人关爱、希望感到对家庭有
用、希望了解检查结果、希望家人陪伴和希望了解治疗效果。
经相关分析发现，自理能力与生理需求呈负相关;住院次数
与心理需求程度高呈正相关。经t检验(LSD)和单因素方差分析
发现，性别、年龄、文化程度、宗教等因素对需求程度影响无差
异。经t检验，在a=0.05时，已婚与离异两组之间、住院次数1
第四军医大学硕士学位论文
次与3次两组之间、完全自理与完全不能自理之间有差异。
结论:
构建了“晚期癌症病人需求评估体系”，经临床初步验证有较
好的信度、效度和可行性，可以用于晚期癌症住院病人需求评估。
Aim: An instrument of assessing the terminally ill cancer patient' needs was supply for clinical nurses by developing index system of evaluation of the terminally ill cancer patient' needs to improve theirs ability of evaluating the terminally ill cancer patient' needs. Methods: 1. Item generation : 甌he items of evaluation system were collected by literature search, seeking advices from two doctors, two nurses, three terminally ill cancer inpatients and three cancer patients in convalescent period. ㏕he items of evaluation system were elected with Delphi method by two experts panels, semi-structured interviewing four terminal ill cancer patients and twenty pre-interview terminal ill cancer patients.
2. Clinical primary application of the index system of evaluation of the terminally ill cancer patient' needs. Prevalence survey of physiological, psychological, social needs and spirit support of 96
terminally ill cancer patients was conducted in 2 hospitals in xi'an. Validity, reliability and feasibility of the index system of evaluation of the terminally ill cancer patients' need were estimated by statistics according to data. Results:
1. The evaluating system of the terminally ill cancer patients' needs was built which consists of 3 grade indexs, there are 4 items in grade 1, 12 items in grade 2, 41 items in grade 3.We use 4 ranks to score them. High degree of needs that has 3 grades (high, middle, low).
2. The index system of evaluation of the terminally ill cancer patients' needs have satisfactory validity and reliability. The questionnaire's response rate of was 98%, test-retest was 87.5% and completion rate was 97.96%. These indicated this questionnaire was feasible to use. Total Pearson's correlation coefficient was 0.827. Pearson's correlation coefficient of physiological, psychological, social and spiritual support was 0.823, 0.636, 0.796, and 0.875, respectively. It explained test-retest reliability. Cronbach's a Coefficient of physiological, psychological, social and spiritual support was 0.7219, 0.6412, 0.7502, and 0.8275, respectively. It represent inter-item consistency. 12 principal components with eigenvalue > 1 were extracted by principal component analysis and varimax orthogonal rotation methods. Its cumulative was 71.81%. These 12 principal components including physiological, psychological, social and spiritual support domains. It
indicated satisfactory construct -related validity. 3. The need degree of majority of 96 terminally ill cancer patients was middle or high degree. It consists of 37.4% high need degree, 39.6% middle need degree and 22.9% low need degree, respectively. Psychological, social and spiritual support for terminally ill cancer patients was high than physiological support for them. The rate of patients needs the high psychological, social, spiritual and physiological support were 54.2%, 50.2%, 62.5% and 10.4%, respectively.
The need degree of terminally ill cancer patients was ranked according to the mean of every item. From range 1 to range 17 were high need degree. These 5 items (from range 1 to range 5) were high need degree (the need for caring of family member; the need for contributing to family; the need for knowing inspection results; the need for companioning with family member; the need for knowing curative effect). These 15 items (from range 18 to range 33) were middle need degree. These 7 items (from range 34 to range 41) were low need degree.
According to t test and A one-way analysis of variance (ANOVA) test, sex, age, marriage, educational history and religion did not influence the need degree of terminally ill cancer patients. Self-care ability was negative correlation with physiological need (r=-0.371 , P =0.000) . The need degree was high when Self-care ability was low. When the patient was in hospital fist time, he need high psychological support. Conclusion: To develop index system of evaluation of the terminally
ill cancer patient' needs successfully. This system has satisfactory validity an
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