终末期心力衰竭患者预立医疗照护计划干预方案的构建及应用研究

doi:10.3761/j.issn.1672-9234.2024.10.016

摘要/Abstract

摘要：

目的构建预立医疗照护计划干预方案,并探讨其在终末期心力衰竭患者中的应用效果。方法引入心力衰竭特定问题提示列表手册,结合其制订预立医疗照护计划干预方案。2022年1月—2023年6月,选取某三级甲等医院收治的80例终末期心力衰竭患者为研究对象,按入住病区将其分为试验组(n=40)和对照组(n=40)。对照组接受常规护理,试验组在对照组基础上接受基于预立医疗照护计划干预方案的干预。比较两组干预前后死亡焦虑、生命意义感和优逝期望量表得分。结果共74例患者完成本研究(试验组35例、对照组39例)。干预前,两组死亡焦虑、生命意义感和优逝期望量表得分比较,差异无统计学意义(P>0.05);干预后,试验组死亡焦虑量表得分低于对照组,患者生命意义感、优逝期望量表得分高于对照组(均P<0.05)。结论预立医疗照护计划干预方案的运用有助于降低终末期心力衰竭患者死亡焦虑水平,增强其生命意义感,提高其优逝期望值。

关键词: 心力衰竭, 预立医疗照护计划, 问题提示列表, 终末期

Abstract:

Objective To construct an advance care planning(ACP) intervention program and explore its effectiveness in patients with end-stage heart failure(ESHF). Methods Based on the heart-failure-specific question prompt list,the ACP intervention program was developed. From January 2022 to June 2023,80 patients with ESHF admitted to a tertiary hospital were recruited and divided into an experimental group(n=40) and a control group (n=40) based on their ward assignments. The control group received routine care,while the experimental group received the ACP intervention program in addition to routine care. Before and after the intervention,scores on the Templer’s Death Anxiety Scale(T-DAS),Meaning in Life Questionnaire(MLQ),Good Death Inventory(GDI) were compared between the two groups. Results A total of 74 patients completed the study(35 from the experimental group and 39 from the control group). Before the intervention,there were no statistically significant differences in the scores of the T-DAS,MLQ,and GDI between the two groups(P>0.05). After the intervention,the experimental group had lower T-DAS scores and higher MLQ and GDI scores compared to those in the control group(all P<0.05). Conclusion The application of the ACP intervention program can help reduce death anxiety,enhance feelings of meaning in life,and improve expectations for a good death among patients with ESHF.

Key words: Heart Failure, Advance Care Planning, Question prompt list, End stage

徐榆林, 郝献芳, 陈倩, 李豪, 白井双, 芦雨, 王晓东. 终末期心力衰竭患者预立医疗照护计划干预方案的构建及应用研究[J]. 中华护理教育, 2024, 21(10): 1247-1254.

XU Yulin, HAO Xianfang, CHEN Qian, LI Hao, BAI Jingshuang, LU Yu, WANG Xiaodong. Construction of advance care planning intervention program and its application in patients with end-stage heart failure[J]. Chinese Journal of Nursing Education, 2024, 21(10): 1247-1254.

图/表 7

图1

表1

表2

表3

表4

表5

表6

参考文献 25

[1]	Savarese G, Becher PM, Lund LH, et al. Global burden of heart failure:a comprehensive and updated review of epidemiology[J]. Cardiovasc Res, 2023, 118(17):3272-3287.
[2]	王华, 刘宇佳, 杨杰孚. 心力衰竭流行病学[J]. 临床心血管病杂志, 2023, 39(4):243-247.
	Wang H, Liu YJ, Yang JF. Epidemiology of heart failure[J]. J Clin Cardiol, 2023, 39(4):243-247.
[3]	Greene SJ, Triana TS, Ionescu-Ittu R, et al. Patients hospitalized for de novo versus worsening chronic heart failure in the United States[J]. J Am Coll Cardiol, 2021, 77(7):1023-1025.
[4]	Kida K, Doi S, Suzuki N. Palliative care in patients with advanced heart failure[J]. Heart Fail Clin,2020,16(2):243-254.
[5]	何东梅, 高茜, 胡建萍, 等. 终末期患者与家属治疗决策一致性研究[J]. 护理学杂志, 2019, 34(10):80-83.
	He DM, Gao Q, Hu JP, et al. Consistency on end-of-life decision-making in terminal-stage patients and their families[J]. J Nurs Sci, 2019, 34(10):80-83.
[6]	王心茹, 绳宇. 生前预嘱、预立医疗指示和预立医疗照护计划的概念关系辨析[J]. 医学与哲学, 2020, 41(24):1-4,14.
	Wang XR, Sheng Y. Analysis of conceptual relationships among living will,advance directives and advance care planning[J]. Med Philos, 2020, 41(24):1-4,14.
[7]	朱婷婷, 陈长英, 刘东玲, 等. 郑州市社区居民预立医疗照护计划认知及态度的现状调查[J]. 中华护理杂志, 2020, 55(5):751-755. doi: 10.3761/j.issn.0254-1769.2020.05.0024
	Zhu TT, Chen CY, Liu DL, et al. Study on the status and influencing factors of cognition and attitude of community residents on advance care planning in Zhengzhou[J]. Chin J Nurs, 2020, 55(5):751-755. doi: 10.3761/j.issn.0254-1769.2020.05.0024
[8]	韩知浩, 方勇, 蔡燕吉, 等. 晚期癌症患者主要照顾者参与预立医疗照护计划障碍的质性研究[J]. 中华护理杂志, 2023, 58(21):2624-2630. doi: 10.3761/j.issn.0254-1769.2023.21.009
	Han ZH, Fang Y, Cai YJ, et al. Qualitative research on the barriers of surrogate decision-makers participating in advanced care planning of patients with advanced cancer[J]. Chin J Nurs, 2023, 58(21):2624-2630. doi: 10.3761/j.issn.0254-1769.2023.21.009
[9]	马瑞瑞, 马红梅. 临终沟通辅助工具的研究进展[J]. 护理研究, 2023, 37(8):1420-1425.
	Ma RR, Ma HM. Research progress on hospice communication aids[J]. Chin Nurs Res, 2023, 37(8):1420-1425.
[10]	Eggly S, Tkatch R, Penner LA, et al. Development of a question prompt list as a communication intervention to reduce racial disparities in cancer treatment[J]. J Cancer Educ, 2013, 28(2):282-289. doi: 10.1007/s13187-013-0456-2 pmid: 23440665
[11]	Hjelmfors L, van der Wal MHL, Friedrichsen M, et al. Optimi-zing of a question prompt list to improve communication about the heart failure trajectory in patients,families,and health care professionals[J]. BMC Palliat Care, 2020, 19(1):161. doi: 10.1186/s12904-020-00665-3 pmid: 33059632
[12]	Hjelmfors L, Strömberg A, Friedrichsen M, et al. Using co-design to develop an intervention to improve communication about the heart failure trajectory and end-of-life care[J]. BMC Palliat Care, 2018, 17(1):85. doi: 10.1186/s12904-018-0340-2 pmid: 29890974
[13]	Metra M, Tomasoni D, Adamo M, et al. Worsening of chronic heart failure:definition,epidemiology,management and preven-tion. A clinical consensus statement by the Heart Failure As-sociation of the European Society of Cardiology[J]. Eur J Heart Fail, 2023, 25(6):776-791.
[14]	McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guide-lines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur Heart J,2021, 42(36):3599-3726. doi: 10.1093/eurheartj/ehab368 pmid: 34447992
[15]	李豪, 景孟娟, 徐榆林, 等. 预立医疗照护计划在血液透析患者中的应用研究[J]. 中华护理杂志, 2022, 8(6):645-650.
	Li H, Jing MJ, Xu YL, et al. The application effect of advance care planning in hemodialysis patients[J]. Chin J Nurs, 2022, 8(6):645-650.
[16]	Hjelmfors L, Mårtensson J, Strömberg A, et al. Communication about prognosis and end-of-life in heart failure care and ex-periences using a heart failure question prompt list[J]. Int J Environ Res Public Health, 2022, 19(8):4841.
[17]	Templer DI. The construction and validation of a Death Anxiety Scale[J]. J Gen Psychol, 1970, 82(2d Half):165-177. doi: 10.1080/00221309.1970.9920634 pmid: 4394812
[18]	杨红, 李艳琳, 姚秋丽, 等. 中文版死亡焦虑量表的应用及对死亡教育的启示[J]. 护理学杂志, 2013, 28(21):64-67.
	Yang H, Li YL, Yao QL, et al. Application of the Chinese version of Templer-Death Anxiety Scale:enlightenment for death education[J]. J Nurs Sci, 2013, 28(21):64-67.
[19]	Steger MF, Frazier P, Oishi S, et al. The meaning in life questionnaire:assessing the presence of and search for meaning in life[J]. J Couns Psychol, 2006, 53(1):80-93.
[20]	刘思斯, 甘怡群. 生命意义感量表中文版在大学生群体中的信效度[J]. 中国心理卫生杂志, 2010, 24(6):478-482.
	Liu SS, Gan YQ. Reliability and validity of the Chinese version of the Meaning in Life Questionnaire[J]. Chin Ment Health J, 2010, 24(6):478-482.
[21]	Miyashita M, Morita T, Sato K, et al. Good death inventory:a measure for evaluating good death from the bereaved family member’s perspective[J]. J Pain Symptom Manage, 2008, 35(5):486-498.
[22]	曾铁英, 毛秋婷, 吴辉. 中文版优逝期望量表信效度分析[J]. 中华现代护理杂志, 2016, 22(34):4897-4901.
	Zeng TY, Mao QT, Wu H. Analysis on the reliability and validity of Chinese version of good death inventory[J]. Chin J Mod Nurs, 2016, 22(34):4897-4901.
[23]	赵浩梅, 汪张毅, 闫伟, 等. 肿瘤科护士死亡焦虑现状及影响因素分析[J]. 护理学杂志, 2023, 38(4):79-82.
	Zhao HM, Wang ZY, Yan W, et al. Death anxiety and the associated factors among oncology nurses[J]. J Nurs Sci, 2023, 38(4):79-82.
[24]	Yang H, Lu YH, Gu YH, et al. Death anxiety among advanced cancer patients:a cross-sectional survey[J]. Support Care Cancer, 2022, 30(4):3531-3539. doi: 10.1007/s00520-022-06795-z pmid: 35018522
[25]	张锦欣, 靳英辉, 曹英娟, 等. 慢性病终末期患者优逝期望与需求质性研究的系统评价[J]. 中华护理杂志, 2019, 54(12):1788-1794. doi: 10.3761/j.issn.0254-1769.2019.12.005
	Zhang JX, Jin YH, Cao YJ, et al. Expectation and needs of a good death in patients with end-stage chronic diseases:a systematic review[J]. Chin J Nurs, 2019, 54(12):1788-1794. doi: 10.3761/j.issn.0254-1769.2019.12.005