Wool Charlotte, Northam Sally
University of Texas at Tyler, USA.
Adv Neonatal Care. 2011 Dec;11(6):397-403. doi: 10.1097/ANC.0b013e318233809a.
To devise and test an instrument measuring clinician perceptions of perinatal palliative care (PPC) and barriers to care delivery.
PPC was theorized to involve the care of pregnant women and their families after prenatal testing resulted in a life-limiting fetal diagnosis. Both giving birth to a child with a life-limiting condition or termination of pregnancy for fetal anomaly can be emotionally traumatic life events. Clinicians were thought to face ethical dilemmas that involved approaches to care for this population. The ethical dilemmas were measured on a perceptions scale using items about informed consent, justice, beneficence, and autonomy. Barriers were theorized as obstacles to delivering quality PPC and included insufficient education, personal discomfort, and difficulty garnering team or administrative support for care.
Licensed clinicians practicing in the perinatal field.
Stage 1 entailed instrument development and validation, which was achieved through a Delphi study involving 11 expert panelists. The devised instrument included 64 six-point Likert items. In stage 2, a computer survey gathered data from a multidisciplinary, clinician group.
A total of 264 clinicians completed the survey. Exploratory factor analysis with varimax rotation was used to validate the instrument, evaluate the factors, and summarize the explained variance achieved by sum scores of the perceptions and barriers scales.
The perceptions scale was reduced to 23 items with a 6-factor solution explaining 67% of the variance with a good internal consistency reliability of 0.77 (Cronbach α). The 22-item barriers scale had a 6-factor solution explaining 71% of the variance with an alpha reliability of 0.83.
The Perinatal Palliative Care Perceptions and Practice Barriers Scale instrument is a valid and reliable measure of PPC perceptions and barriers for measuring the attitudes of physicians and nurses.
Use of this instrument can foster educational programs and hospital planning for PPC teams that provide grieving families with the varied support they need. It is also a useful instrument for examining trends in the clinician perspectives and practice barriers as more genetic testing and subsequent terminal diagnoses occur.
设计并测试一种用于测量临床医生对围产期姑息治疗（PPC）的认知以及护理实施障碍的工具。
PPC的理论基础是，在产前检查得出胎儿患有危及生命的疾病诊断后，为孕妇及其家庭提供护理。生下患有危及生命疾病的孩子或因胎儿异常而终止妊娠，都可能是情感上具有创伤性的人生事件。临床医生被认为面临涉及对这一人群护理方法的伦理困境。这些伦理困境通过关于知情同意、公正、行善和自主的项目，在一个认知量表上进行测量。障碍被理论化为提供高质量PPC的阻碍，包括教育不足、个人不适以及难以获得团队或行政部门对护理的支持。
在围产期领域执业的有执照临床医生。
第一阶段涉及工具的开发和验证，这通过一项包括11名专家小组成员的德尔菲研究得以实现。设计的工具包括64个六点李克特量表项目。在第二阶段，通过计算机调查收集来自多学科临床医生群体的数据。
共有264名临床医生完成了调查。采用方差最大化旋转的探索性因素分析来验证该工具、评估因素，并总结通过认知和障碍量表总分所实现的解释方差。
认知量表缩减为23个项目，采用六因素解决方案，解释了67%的方差，内部一致性信度良好，为0.77（克朗巴哈α系数）。22个项目的障碍量表采用六因素解决方案，解释了71%的方差，α信度为0.83。
围产期姑息治疗认知与实践障碍量表工具是一种有效且可靠的测量PPC认知和障碍的工具，可用于测量医生和护士的态度。
使用该工具可以促进为PPC团队开展教育项目和医院规划，为悲伤的家庭提供他们所需的各种支持。随着更多基因检测及后续终末期诊断的出现，它也是一种用于研究临床医生观点和实践障碍趋势的有用工具。
