Fakhoury W, McCarthy M, Addington-Hall J
Department of Epidemiology and Public Health, University College London Medical School, England.
Soc Sci Med. 1996 Mar;42(5):721-31. doi: 10.1016/0277-9536(95)00198-0.
The association between bereaved informal caregivers' satisfaction with services delivered by district nurses, general practitioners and hospital doctors, and various service and non-service variables was examined to assess whether satisfaction is a reflection of service characteristics, non-service related factors, or attributable to both. Secondary analysis was undertaken on a sub-sample from the "Regional Study of Care for the Dying" (RSCD) in which bereaved relatives or friends of a random sample of deaths in 1990 in 20 health districts across England were interviewed some ten months after the death. 1858 relatives or close friends/neighbours of people who died from cancer were included in this analysis. Using multiple logistic regression, larger odds ratio were found in association with service than non-service variables. For example, high satisfaction with district nurses was strongly associated with visiting the patient very frequently (OR = 10.8, 95% CI = 4.5 - 25.9), while the GP visiting 20 times or more (OR = 5.5, 95% CI = 3.6 - 8.5), and informing the informal caregiver of the diagnosis (OR = 3.3, 95% CI = 2.3 - 4.7) were associated with high satisfaction with GPs. However, some non-service variables were significantly associated with satisfaction. For instance, having no bereavement-related psychological problems was positively associated with high satisfaction with district nurses (OR = 2.3, 95% CI = 1.6 - 3.4) and GPs (OR = 2.0, 95% CI = 1.4 - 2.8), while the informal caregiver perceiving caring as rewarding as opposed to a burden was positively associated with high satisfaction with district nurses (OR = 3.7, 95% CI = 1.8 - 7.5) and negatively associated with high satisfaction with hospital doctors (OR = 0.46, 95% CI = 0.24 - 0.86). The findings indicate that, in post-bereavement surveys evaluating services delivered to dying cancer patients, informal caregivers' satisfaction is mainly determined by service characteristics. However, attributes of both patients and informal caregivers also play an important role.
本研究探讨了丧亲的非正式照护者对地区护士、全科医生和医院医生所提供服务的满意度与各种服务及非服务变量之间的关联，以评估满意度是服务特征、非服务相关因素的反映，还是两者共同作用的结果。对“临终关怀区域研究”（RSCD）的一个子样本进行了二次分析，该研究对1990年英格兰20个健康区随机抽取的死亡样本中的丧亲亲属或朋友在其亲人死亡约十个月后进行了访谈。本分析纳入了1858名癌症死亡患者的亲属或亲密朋友/邻居。使用多元逻辑回归分析发现，与满意度相关的服务变量的优势比大于非服务变量。例如，对照护护士的高度满意与频繁探访患者密切相关（优势比=10.8，95%置信区间=4.5-25.9），而全科医生探访20次或更多（优势比=5.5，95%置信区间=3.6-8.5）以及告知非正式照护者诊断结果（优势比=3.3，95%置信区间=2.3-4.7）与对照护医生的高度满意相关。然而，一些非服务变量也与满意度显著相关。例如，没有与丧亲相关的心理问题与对照护护士（优势比=2.3，95%置信区间=1.6-3.4）和全科医生（优势比=2.0，95%置信区间=1.4-2.8）的高度满意呈正相关，而非正式照护者认为照护是一种回报而非负担与对照护护士的高度满意呈正相关（优势比=3.7，95%置信区间=1.8-7.5），与对医院医生的高度满意呈负相关（优势比=0.46，95%置信区间=0.24-0.86）。研究结果表明，在评估为临终癌症患者提供服务的丧亲后调查中，非正式照护者的满意度主要由服务特征决定。然而，患者和非正式照护者的属性也起着重要作用。
