終末期病人及家屬參與安寧療護共享決策體驗的Meta整合

Experience of end-stage patients and their families participating in shared decision-making for hospice care：a Meta-integration

ZHANG Qian，LU Yulin，LU Yan，CAO Mingrui，WANG Xiaoqin，SHI ShuyuSchool of Nursing，Kunming Medical University，Yunnan 650500 ChinaCorresponding Author LU Yulin，E-mail：653587668@qq.com

Abstract Objective：To systematically evaluate the qualitative study of end-stage patients and their families participating in shared decision making in hospice care，and to provide evidence-based evidence for the application of shared decision making in hospice patients.Methods：Relevant qualitative studies were retrieved from PubMed，Web of Science，the Cochrane Library，CNKI，VIP，WanFang Database，etc.The retrieval time was from the establishment of each database to May 2023.The included literature was evaluated according to the Joanna Briggs Institute（JBI） qualitative research quality evaluation criteria，and the results were integrated using a pooled integration method.Results：A total of 7 articles were included，and 28 research results were extracted and summarized into 8 categories.It is further integrated into three major themes，including the prerequisite for sharing decision-making between terminal patients and their families，the influencing factors for sharing decision-making between terminal patients and their families，and the troubling factors for sharing decision-making between terminal patients and their families.Conclusion：In the future，we should promote the implementation of shared decision making in hospice care from many aspects，such as patient autonomy，doctor-patient relationship，intermediary role，ACP and psychological support.

Keywords palliative care;shared decision-making;end stage;Meta-integration;evidence-based nursing;qualitative research

摘要 目的：系統評價終末期病人及家屬參與安寧療護共享決策體驗的質性研究，為共享決策在安寧療護病人中的應用提供循證依據。方法：計算機檢索PubMed、Web of Science、the Cochrane Library、中國知網、維普數據庫、萬方數據庫等建庫至2023年5月發表的相關質性研究，根據Joanna Briggs Institute（JBI）質性研究質量評價標準對納入文獻進行評價，運用匯集性整合方法進行結果整合。結果：共納入7篇文獻，提煉出28個研究結果，歸納為8個類別，進一步整合為三大主題：終末期病人及家屬進行共享決策的前提條件、終末期病人及家屬進行共享決策的影響因素、終末期病人及家屬進行共享決策的困擾因素。結論：未來應從病人自主性、醫患關系、中介角色、預立醫療照護計劃及心理支持等多方面促進安寧療護共享決策的實施。

關鍵詞 安寧療護；共享決策；終末期；Meta整合；循證護理；質性研究

doi：10.12102/j.issn.2095-8668.2024.14.006

安寧療護（hospice care）指由醫務人員和志愿者為終末期（生存時限≤6個月）病人及家屬提供生理、心理、精神和社會支持全方位的照護［1］。自2016年《“健康中國2030”規劃綱要》首度將安寧療護名詞寫入綱要，至2022年《“十四五”國民健康規劃》提出，穩步擴大安寧療護試點工作，我國安寧療護工作不斷規范與完善［2］。共享決策（shared decision making，SDM）是醫患雙方在平等及尊重病人偏好和價值觀的基礎上，通過充分溝通和討論，達到醫患信息共享和決策一致的過程［3］。共享決策強調以病人為中心、尊重病人選擇，越來越被提倡為偏好敏感決策的模式［4］。目前，共享決策被用于腫瘤［5］、慢性病［6］、心血管疾?。?］、終末期腎?。?］、重癥監護室［9］等病人，均取得較好的效果?！?br>