Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2021 Mar 1;84(3):280-284. doi: 10.1097/JCMA.0000000000000484.
This study aimed to evaluate the differences in nurses' willingness to discuss palliative care with terminally ill patients and their family members.
The participants were randomly recruited from registered staff nurses ≥20 years of age who were responsible for clinical inpatient care in a tertiary hospital in northern Taiwan. A semi-structured questionnaire was administered to evaluate nurses' experiences of discussing do-not-resuscitate (DNR) decisions and their willingness to discuss palliative care with terminal patients and their family members. The differences in nurses' experiences regarding DNR and willingness to discuss palliative care with terminally ill patients and their family members were compared using the Chi-square test. Logistic regressions were used to analyze factors associated with nurses' willingness to discuss palliative care with patients and their families.
More participants had experienced initiating discussions about DNR with patients' families than with patients (72.2% vs 61.9%, p < 0.001). Unadjusted logistic regression analysis showed that the experiences of actively initiating DNR discussions with patients were a significant factor associated with palliative care discussion with patients (odds ratio [OR] = 2.91, 95% confidence interval [CI]: 1.09-7.79). On the other hand, the experiences of actively initiating DNR discussions with patients and with patients' families were significant factors associated with palliative care discussion with patients' families (OR = 3.84, 95% CI: 1.22-12.06 and OR = 3.60, 95% CI: 1.19-10.90, respectively). After adjusting for covariates, no significant factors were found to be independently associated with nurses' willingness to discuss palliative care with patients and their family members.
There are significant differences in nurses' willingness to discuss palliative care with patients and their family members. Further research is needed to evaluate factors associated with nurses' willingness to discuss palliative care with patients and their families to facilitate these discussions and protect patients' autonomy.
本研究旨在评估护士与终末期患者及其家属讨论姑息治疗意愿的差异。
参与者从台湾北部一家三级医院负责临床住院护理的注册护士中随机招募，年龄≥ 20 岁。采用半结构式问卷评估护士讨论不复苏（DNR）决策的经验及其与终末期患者及其家属讨论姑息治疗的意愿。采用卡方检验比较护士在 DNR 方面的经验和与终末期患者及其家属讨论姑息治疗意愿的差异。采用逻辑回归分析与护士与患者及其家属讨论姑息治疗意愿相关的因素。
与与患者相比，更多的参与者有与患者家属主动讨论 DNR 的经验（72.2% 对 61.9%，p < 0.001）。未经调整的逻辑回归分析显示，与患者主动讨论 DNR 的经验是与患者讨论姑息治疗的显著相关因素（优势比[OR] = 2.91，95%置信区间[CI]：1.09-7.79）。另一方面，与患者和患者家属主动讨论 DNR 的经验是与患者家属讨论姑息治疗的显著相关因素（OR = 3.84，95%CI：1.22-12.06 和 OR = 3.60，95%CI：1.19-10.90）。调整协变量后，未发现与护士与患者及其家属讨论姑息治疗意愿相关的显著因素。
护士与患者及其家属讨论姑息治疗的意愿存在显著差异。需要进一步研究评估与护士与患者及其家属讨论姑息治疗意愿相关的因素，以促进这些讨论并保护患者的自主权。
