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南京晚期癌症患者临终关怀中临床医生对共同决策的看法:一项描述性定性研究

Perspectives of clinicians on shared decision making in hospice care for advanced cancer patients in Nanjing: a descriptive qualitative study.

作者信息

Pang Tianyu, Yan Kairan, Zhou Yujie, Sun Lulu, Wu Ligui, Yuan Ling, Zhou Zhi

机构信息

Department of Oncology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.

School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.

出版信息

BMC Palliat Care. 2025 May 22;24(1):145. doi: 10.1186/s12904-025-01770-x.

Abstract

BACKGROUND

As the cancer burden increases in China, the need for hospice care is escalating. The right of informed consent to hospice care for patients with advanced cancer is still at the experimental stage, and patients still face numerous obstacles when it comes to participating in hospice care decision-making. In this context, we conducted a qualitative study to explore perspectives of clinicians on shared decision making (SDM) in hospice care for advanced cancer patients.

METHODS

This study employed a descriptive phenomenological research method. We conducted semi-structured interviews with clinicians recruited from 4 hospital in Nanjing, Jiangsu Province, China from January to March 2023. Two researchers used Colaizzi 7-step analysis method to analyze, summarize, integrate and refine the data.

RESULTS

A total of 17 clinicians participated. Three main themes were extracted: (1) Clinician attitudes regarding SDM; (2) Influencing factors are multidimensional; (3) Recommendations for implementing SDM in hospice care decision-making.

CONCLUSION

SDM in hospice care for advanced cancer patients was affected by multiple factors in medical practice. It is highly desirable to focus on improving the decision support system, optimizing the SDM model of hospice care to ensure the informed choice of patients with advanced cancer.

摘要

背景

随着中国癌症负担的增加,临终关怀的需求不断升级。晚期癌症患者接受临终关怀的知情同意权仍处于试验阶段,患者在参与临终关怀决策时仍面临诸多障碍。在此背景下,我们开展了一项定性研究,以探讨临床医生对晚期癌症患者临终关怀共同决策(SDM)的看法。

方法

本研究采用描述性现象学研究方法。2023年1月至3月,我们对从中国江苏省南京市4家医院招募的临床医生进行了半结构化访谈。两名研究人员采用Colaizzi 7步分析法对数据进行分析、总结、整合和提炼。

结果

共有17名临床医生参与。提取了三个主要主题:(1)临床医生对共同决策的态度;(2)影响因素是多维度的;(3)在临终关怀决策中实施共同决策的建议。

结论

晚期癌症患者临终关怀中的共同决策在医疗实践中受到多种因素的影响。非常有必要关注改进决策支持系统,优化临终关怀共同决策模式,以确保晚期癌症患者的知情选择。

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