Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi.
Jpn J Clin Oncol. 2014 Aug;44(8):718-28. doi: 10.1093/jjco/hyu075. Epub 2014 Jun 19.
We investigated palliative care knowledge, difficulty and self-reported practice among a region-wide sample of nurses who cared for cancer patients in Japan.
A cross-sectional questionnaire survey was distributed to 9 designated cancer centers, 17 community hospitals and 73 district nurse services across 4 regions in 2008. We used the Palliative Care Knowledge Test, the Palliative Care Difficulty Scale (five-point Likert scale) and the Palliative Care Self-Reported Practices Scale (five-point Likert scale).
In total, 2378 out of 3008 nurses (79%) responded. The knowledge, difficulty and self-reported practice scores were 51 ± 20%, 3.2 ± 0.7 and 3.7 ± 0.6, respectively. In the knowledge test, philosophy scored highest (88 ± 26%) and psychiatric problems scored lowest (37 ± 29%). In the difficulty test, alleviating symptoms scored most difficult (3.5 ± 0.8) and providing expert support scored least difficult (2.9 ± 1.3). In the self-reported practice questionnaire, pain and delirium relief were most frequently (4.0 ± 0.8) and least frequently (3.1 ± 0.9) provided, respectively. Knowledge was significantly poorer in community hospitals (P = 0.035); difficulty scores were significantly higher in community hospitals (P < 0.001) and district nurse services (P = 0.013); and self-reported practice scores were significantly poorer in community hospitals (P < 0.001) but superior in district nurse services (P < 0.001) than in designated cancer centers.
Knowledge, difficulty and self-reported practice for symptom management, particularly psychological symptoms, were insufficient, particularly in community hospitals. Education, expert support and adequate clinical experiences would help provide quality palliative care.
我们调查了日本癌症患者护理护士的姑息治疗知识、困难和自我报告的实践情况。
2008 年，我们对 4 个地区的 9 个指定癌症中心、17 家社区医院和 73 家地区护士服务机构进行了横断面问卷调查。我们使用了姑息治疗知识测试、姑息治疗困难量表（五分李克特量表）和姑息治疗自我报告实践量表（五分李克特量表）。
共有 3008 名护士中的 2378 名（79%）做出了回应。知识、困难和自我报告实践的评分分别为 51±20%、3.2±0.7 和 3.7±0.6。在知识测试中，哲学得分最高（88±26%），精神问题得分最低（37±29%）。在困难测试中，缓解症状最难（3.5±0.8），提供专家支持最容易（2.9±1.3）。在自我报告实践问卷中，疼痛和谵妄缓解最频繁（4.0±0.8），最不频繁（3.1±0.9）。社区医院的知识明显较差（P=0.035）；社区医院（P<0.001）和地区护士服务（P=0.013）的困难评分显著较高；社区医院（P<0.001）但地区护士服务（P<0.001）的自我报告实践评分明显较差。
症状管理，特别是心理症状的姑息治疗知识、困难和自我报告实践不足，特别是在社区医院。教育、专家支持和充足的临床经验将有助于提供优质的姑息治疗。
