Xiang Yi Rong, Ning Xiao Hong
Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Chin Med Sci J. 2018 Dec 30;33(4):221-227. doi: 10.24920/003509.
Objective To investigate doctors' feelings when providing medical care to end-stage patients, and their understanding as well as reflection about theoretical concepts of palliative medicine. Methods Questionnaires were delivered through a social networking platform to 1500 clinicians of different specialties in 10 proviences of China. It covered issues of background information, self-assessment of familiarity to palliative care, prior training history, emotional attitude toward end-stage patients, and the reflections on clinical practice. Logistic regression analysis and chi-square test were used to analyse the categorical variables. Results There were 379 clinicians who completed the questionnaires and submitted successfully. Among them, 66.8% (253/379) had attended palliative care training courses more than twice; 66.8% (253/379) clinicians percieved powerless feeling when facing end-stage patients. We found that the education on palliative medicine was significantly associated to doctors' better comprehension on the concept of palliative care (OR=6.923, P=0.002). Doctors who were more familiar with palliative medicine were less likely to perceive powerless feelings (χ =13.015, P<0.001), and would be more likely to concern about patients and their family members in their clinical work (χ =28.754, P<0.001, χ =24.406, P<0.001). Conclusion The powerless feeling is prevalent in Chinese doctors when facing end-stage patients. Palliative care help them overcome the negative feelings and act more caring in clinic. More careful designed educational strategies that adapt to Chinese actual situation are needed to improve doctors' cognition on palliative care.
目的 调查医生在为终末期患者提供医疗服务时的感受，以及他们对姑息医学理论概念的理解和思考。方法 通过社交网络平台向中国10个省份的1500名不同专业的临床医生发放问卷。问卷涵盖背景信息、对姑息治疗熟悉程度的自我评估、既往培训经历、对终末期患者的情感态度以及对临床实践的思考等问题。采用Logistic回归分析和卡方检验对分类变量进行分析。结果 共有379名临床医生完成问卷并成功提交。其中，66.8%（253/379）参加过两次以上姑息治疗培训课程；66.8%（253/379）的临床医生在面对终末期患者时感到无力。我们发现，姑息医学教育与医生对姑息治疗概念的更好理解显著相关（OR=6.923，P=0.002）。对姑息医学更熟悉的医生较少感到无力（χ =13.015，P<0.001），并且在临床工作中更有可能关心患者及其家属（χ =28.754，P<0.001，χ =24.406，P<0.001）。结论 中国医生在面对终末期患者时普遍存在无力感。姑息治疗有助于他们克服负面情绪，在临床中表现得更有爱心。需要制定更符合中国实际情况的精心设计的教育策略，以提高医生对姑息治疗的认知。
