Li Yunrong, Ji Yuan, Wang Tiantian, Yang Bo, Gao Fulin, Zhang Liuliu, Zhou Guoren, Zhao Yun
Nursing Department, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China.
Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China.
Asia Pac J Oncol Nurs. 2025 Jun 18;12:100744. doi: 10.1016/j.apjon.2025.100744. eCollection 2025 Dec.
Decision-making of artificial nutrition and hydration (ANH) is a complex ethical and emotional decision in hospice care, significantly impacting patients' comfort and quality of life at the end of life. This study explored behaviors about decision-making of ANH in hospice patients and their family caregivers, aiming to identify the trajectory and influencing factors of the decision.
This study employed constructivist grounded theory. Using purposive and theoretical sampling methods, in-depth interviews were conducted with 21 hospice patients and family caregivers in three Grade IIIA hospitals in Mainland China. Thematic analysis involved initial coding, focused coding, and theoretical coding to develop main categories and core categories.
This study identified a core category, alongside two main categories. A framework titled "The decision-making process of ANH for hospice patients and family caregivers" was developed. This decision-making began with the detection of malnutrition and progressed through five core stages, including "symptom shock", "risk trade-offs", "goal formation", "final decision", and "moral distress". Multiple individual, medical, and social factors influenced the final decision-making process of ANH.
Through the framework, this study can enhance health care providers' understanding of the decision-making process and also can aid in tailoring support to align treatment choices with patients' preferences. The study highlights the interplay between emotional and rational aspects in decision-making of ANH and emphasizes the need for health care providers to recognize individual, medical, and social factors. These findings can enhance the decision-making experience of hospice patients and family caregivers, ultimately improving the quality of hospice care.
在临终关怀中，人工营养与水化（ANH）的决策是一个复杂的伦理和情感决策，对患者临终时的舒适度和生活质量有重大影响。本研究探讨了临终关怀患者及其家庭照顾者在ANH决策方面的行为，旨在确定决策的轨迹和影响因素。
本研究采用建构主义扎根理论。运用目的抽样和理论抽样方法，对中国大陆三家三级甲等医院的21名临终关怀患者及其家庭照顾者进行了深入访谈。主题分析包括初始编码、聚焦编码和理论编码，以形成主要类别和核心类别。
本研究确定了一个核心类别以及两个主要类别。构建了一个名为“临终关怀患者及其家庭照顾者的ANH决策过程”的框架。该决策始于对营养不良的察觉，并经历了五个核心阶段，包括“症状冲击”“风险权衡”“目标形成”“最终决策”和“道德困扰”。多个个人、医疗和社会因素影响了ANH的最终决策过程。
通过该框架，本研究可以增进医护人员对决策过程的理解，也有助于提供针对性的支持，使治疗选择与患者偏好相匹配。该研究强调了ANH决策中情感和理性方面的相互作用，并强调医护人员需要认识到个人、医疗和社会因素。这些发现可以改善临终关怀患者及其家庭照顾者的决策体验，最终提高临终关怀的质量。
