参与癌症患者生命末期讨论的护理实践方案构建研究

doi:10.3761/j.issn.1672-9234.2024.12.017

摘要/Abstract

摘要：

目的构建参与癌症患者生命末期讨论护理实践方案。方法通过文献检索，从4篇证据总结、8篇临床实践指南、4篇系统评价中提取相关内容，结合对8名护士访谈的结果，形成参与癌症患者生命末期讨论护理实践方案初稿，通过德尔菲法进行2轮专家函询，最终形成实践方案。结果 2轮函询问卷有效回收率均为100%；肯德尔和谐系数分别为0.194和0.291，专家权威系数为0.92。最终形成的参与癌症患者生命末期讨论护理实践方案，包括初次讨论的时机、讨论基本原则与目标、制订讨论计划、沟通态度与方式、沟通技巧与策略、参与讨论的最佳人选、参与讨论人员所需具备专业技能、躯体症状的讨论、心理情绪的讨论、社会支持的讨论、心灵照护的讨论、照护目标的讨论、中国传统文化与生命末期讨论、再次讨论的时机、目标不一致的沟通策略、讨论的评价指标。结论本研究所构建的护理实践方案，构建过程严谨可靠，内容设置主题明确，具有可操作性和实用意义。

关键词: 护士, 癌症患者, 德尔菲技术, 生命末期, 实践方案

Abstract:

Objective To develop a nursing practice program for early intervention in end-of-life discussions with advanced cancer patients. Methods A literature review was conducted to extract relevant content from four evidence summaries，eight clinical practice guidelines，and four systematic reviews. Combined with interview results from eight nurses，an initial draft of a nursing practice plan for early intervention in end-of-life discussions with advanced cancer patients was developed. The protocol was refined through two rounds of experts consultation using the Delphi method. Results The effective response rate for both rounds of the Delphi survey was 100%；the Kendall’s coefficient of concordance was 0.194 and 0.291，respectively，and the expert authority coefficient was 0.92. The final nursing practice program for early intervention in end-of-life discussion with advanced cancer patients includes 16 recommended topics：timing of the initial discussion，basic principles and objectives of the discussion，developing a discussion plan，communication attitudes and methods，communication skills and strategies，optimal participants for discussion，required professional skills for participants，discussion of physical symptoms，discussion of psychological emotions，discussion of social support，spiritual care discussion，care goals discussion，Chinese traditional culture in end-of-life discussion，timing for re-discussion，communication strategies for conflicting goals，and evaluation indicators for the discussion. Conclusion The nursing practice program developed in this study is rigorously constructed，with well-defined and practical themes that are suitable for guiding end-of-life discussions with patients in advanced-stage cancer.

Key words: Nurses, Cancer patients, Delphi Technique, End-of-life, Practice program

张倩, 杨与珍, 李俊英. 参与癌症患者生命末期讨论的护理实践方案构建研究[J]. 中华护理教育, 2024, 21(12): 1510-1516.

ZHANG Qian, YANG Yuzhen, LI Junying. Development of a nursing practice program for early intervention in end-of-life discussions with advanced cancer patients[J]. Chinese Journal of Nursing Education, 2024, 21(12): 1510-1516.

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