患者在姑息治疗中对药物犹豫不决的相关信念：使用计划行为理论的系统评价。
Patient beliefs associated with medication hesitancy in palliative care: A systematic review using the theory of planned behavior.
机构信息
School of Pharmacy, University of Sydney, Sydney, NSW, Australia.
Department of Pharmacy, Chris O'Brien Lifehouse, Sydney, NSW, Australia.
出版信息
Palliat Support Care. 2024 Jun;22(3):610-622. doi: 10.1017/S1478951522001547.
CONTEXT
The demand of palliative care is increasing due to the aging population and treatment hesitancy or intentional avoidance compromises symptom management.
OBJECTIVES
To identify patient beliefs associated with medication hesitancy by using the theory of planned behavior (TPB) namely, attitudes, subjective norms, behavioral intention, and perceived behavioral control associated with medication hesitancy or intentional noncompliance by avoidance.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was followed to conduct a systematic literature search involving the CINAHL, Embase, MEDLINE, and PsycINFO databases from inception until March 2022. Hand-searched articles from reference lists and gray literature were included. Thematic analysis was conducted on qualitative data and triangulated with quantitative data.
RESULTS
About 554 articles were retrieved from the literature search and 17 articles were included based on the eligibility criteria. Three subthemes that were identified under TPB constructs were : negative attitude toward medications, passive attitude toward illness and inaccurate information about disease or medication; one subtheme was identified under : perceived negative opinions from others; and one subtheme was identified under : perception of manageable symptoms. Quantitative data provided triangulation of qualitative findings related to fear of addiction and side effects, feelings of hopelessness, unclear direction and information, social stigma, endurable symptoms, and illness as determinants for medication avoidance.
SIGNIFICANCE OF RESULTS
This systematic review highlighted some patient beliefs related to medication hesitancy or avoidance. Clinicians should take patient beliefs and concerns into consideration when creating treatment regimens for people receiving palliative care to optimize medication adherence and the quality of care.
背景
由于人口老龄化以及治疗犹豫或故意回避会影响症状管理，姑息治疗的需求正在增加。
目的
使用计划行为理论（TPB）即与药物犹豫或故意不遵医嘱回避相关的态度、主观规范、行为意向和感知行为控制，确定与药物犹豫相关的患者信念。
方法
本研究遵循系统评价和荟萃分析的首选报告项目，对 CINAHL、Embase、MEDLINE 和 PsycINFO 数据库进行了系统文献检索，检索时间从建库开始到 2022 年 3 月。纳入了参考文献列表和灰色文献中的手工检索文章。对定性数据进行主题分析，并与定量数据进行三角分析。
结果
从文献检索中检索到约 554 篇文章，根据纳入标准纳入了 17 篇文章。在 TPB 结构下确定了 3 个亚主题：对药物的负面态度、对疾病的消极态度和对疾病或药物信息的不准确；一个亚主题是：来自他人的负面意见感知；一个亚主题是：可管理症状的感知。定量数据提供了与成瘾和副作用恐惧、绝望感、方向和信息不明确、社会耻辱感、可忍受的症状、疾病作为药物回避决定因素相关的定性发现的三角分析。
意义
本系统评价强调了一些与药物犹豫或回避相关的患者信念。临床医生在为接受姑息治疗的患者制定治疗方案时，应考虑患者的信念和顾虑，以优化药物依从性和护理质量。
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