中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2021, Vol. 43 ›› Issue (4): 563-570.doi: 10.3881/j.issn.1000-503X.13594

• 论著 • 上一篇    下一篇

三级医院急诊医师对缓和医疗的认知和能力

杜铁宽1,宁晓红2(),朱华栋1,史迪1,李佳颐3   

  1. 中国医学科学院 北京协和医学院 北京协和医院 1急诊科,北京 100730
    2老年科,北京 100730
    3中国医学科学院 北京协和医学院,北京 100730
  • 收稿日期:2020-11-30 出版日期:2021-08-30 发布日期:2021-09-03
  • 通讯作者: 宁晓红 E-mail:ningxh1973@foxmail.com
  • 基金资助:
    中国医学科学院 北京协和医学院教育教学改革项目(2016zlgc0126)

Cognition and Ability of Emergency Physicians for Palliative Care in Tertiary Hospitals

DU Tiekuan1,NING Xiaohong2(),ZHU Huadong1,SHI Di1,LI Jiayi3   

  1. 1Department of Emergency Medicine,Beijing 100730,China
    2Department of Geriatrics,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
    3CAMS and PUMC,Beijing 100730,China
  • Received:2020-11-30 Published:2021-08-30 Online:2021-09-03
  • Contact: NING Xiaohong E-mail:ningxh1973@foxmail.com
  • Supported by:
    Educational Reform Project of Peking Union Medical College(2016zlgc0126)

摘要:

目的 了解国内急诊医师对缓和医疗的认知和相关能力现况。方法 采用便利抽样法抽取中国115名三级医院急诊医师进行问卷调查。问卷内容包括:基本信息;面对终末期患者/家属的感受、态度;对缓和医疗的认知;个人缓和医疗能力。结果 对缓和医疗认知程度自评为“不了解”、“部分了解”和“充分了解”的急诊医师占比分别为25.2%、59.1%、15.7%。参加过缓和医疗相关讲座的医师32人(27.8%),其自评认知程度更高(P=0.002)。微信(39.1%)、媒体(36.5%)、口口相传(33.0%)是急诊医师获得缓和医疗知识的前3位途径。68.7%的急诊医师面对终末期患者有“无力感”,60.9%和59.1%的医生感到纠结和担心死亡引发纠纷。急诊医师在缓解患者撤除呼吸机后的呼吸困难[3(2,4)]、消除临终恐惧心理[3(3,4)]等方面的能力自评指数较低。急诊医师对缓和医疗的认知程度(自评)与大部分的缓和医疗能力自评指数项呈正相关。结论 讲座对急诊医师的缓和医疗认知程度有显著影响;在自评中,多数缓和医疗能力项与缓和医疗认知程度呈正相关。面对终末期患者时,多数急诊医师存在无力、纠结、担心纠纷等情绪,在缓解患者撤除呼吸机后的呼吸困难、消除临终恐惧心理等方面的能力自评指数较低,相关培训可作为重点。

关键词: 缓和医疗, 教育, 急诊医师, 认知, 态度, 需求, 能力

Abstract:

Objective To understand the cognition and related abilities of emergency physicians for palliative care in China. Methods A total of 115 emergency physicians were selected by convenient sampling to conduct a questionnaire survey.The questionnaire included the physicians’ basic information,feelings and attitudes towards end-stage patients and their families,cognition of palliative care,and personal ability for palliative care. Results 25.2%,59.1%,and 15.7% of the emergency physicians considered they had “no understanding”,“partial understanding”,and “full understanding” of palliative care,respectively.32(27.8%)physicians participated in palliative care-related lectures and they showed higher self-rated cognition levels(P=0.002).Wechat(39.1%),media(36.5%),and word of mouth(33.0%)were the main ways for emergency physicians to acquire the knowledge of palliative care.Among the emergency physicians,68.7% felt “powerless” in the face of end-stage patients,and 60.9% and 59.1% felt tangled and worried about death causing disputes,respectively.The emergency physicians had low self-rated ability in relieving dyspnea after removal of ventilator[3(2,4)]and eliminating the fear of death[3(3,4)].The self-rated cognition level of emergency physicians to palliative care was positively correlated with most of the self-rated ability indexes. Conclusions Lectures have a significant impact on emergency physicians’ cognition level of palliative care.Most of the self-rated indexes of palliative care ability are positively correlated with the cognition level of palliative care.In the face of end-stage patients,most of the emergency physicians are powerless,tangled,and worried about disputes,and their self-rated indexes in relieving dyspnea after removal of ventilator and eliminating the fear of death are low,which necessitates relevant training.

Key words: palliative care, education, emergency physician, cognition, attitude, demand, ability

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