基于NCP框架的安宁疗护质量指标评价体系构建 [中文引用][英文引用]

目的  构建安宁疗护质量指标评价体系，为安宁疗护服务质量评估提供参考依据。方法  以美国国家高质量安宁疗护服务质量评估分析框架（national consensus project for quality palliative care，NCP）为理论框架，2024 年 1 月至 3 月运用文献法、小组讨论法形成安宁疗护服务质量评价体系初稿，邀请 15 名广东省三级甲等综合医院安宁疗护医疗、护理、管理、研究、教育等领域工作的专家展开 2 轮德尔菲函询，并对条目进行权重赋值。结果  15 名函询专家 2 轮专家函询问卷均有效回收，回收率为 100.00%；权威系数（Cr）为 0.855，第 2 轮专家函询一、二、三级指标重要性评分分别为 4.90~5.00 分、4.80~5.00 分、4.37~5.00 分，变异系数（coefficient of variation，CV）分别为 0~0.06、0~0.10、0~0.19，满分比分别为 0.93~1.00、0.80~1.00、0.67~1.00，肯德尔协调系数 W 分别为 0.214、0.287、0.245（均 P<0.01）。9 项一级指标权重系数分别为：护理结构与过程（0.123）、生理照护（0.153）、心理照护（0.110）、社会照护（0.106）、精神照护（0.098）、文化照护（0.082）、濒死期患者的照护（0.119）、照护道德与伦理（0.092）、持续质量改善（0.117）。安宁疗护质量指标评价体系包含一级指标 9 项，二级指标 22 项，三级指标 69 项。结论  本研究基于 NCP 框架构建的安宁疗护质量指标评价体系有一定的科学性与创新性，未来建议在临床应用，验证其效果。

Objective To develop an evaluation system for quality palliative care and provide an evaluation tool for quality palliative care service. Methods A preliminary evaluation system was drafted by using literature review and group discussion， aligning with the U.S. National Consensus Project for Quality Palliative Care（NCP）. The system was revised and refined by two rounds of Delphi consultation with 15 palliative care experts（including specialists in clinical practice，nursing management，nursing research and education）from Tier-IIIA hospitals in Guangdong Province. Indicator weights were determined via consensus. Results Both rounds of expert consultation achieved 100.00% response rates. Expert authority coefficient（Cr）was 0.855. The importance scores of the level-1，level-2 and level-3 indicators of the second round of expert consultation were 4.90-5.00，4.80-5.00 and 4.37-5.00，respectively. Coefficients of variation were 0-0.06，0-0.1 and 0-0.19，respectively. The full score ratio ranged between 0.93 and 1.00，0.8 and 1.00， and 0.67 and 1.00. Kendall's W coefficients were 0.214，0.287 and 0.245，respectively（all P<0.01）. The nine level-1 indicators were identified as care structure and process，physiological care，psychological care，social care，mental care，cultural care，end-of-life care， ethical care and quality improvement，with the weight coefficients of 0.123，0.153，0.110，0.106，0.098，0.082，0.119，0.092 and 0.117， respectively. The final evaluation system for quality palliative care included 9 indicators in level-1，22 in level-2 and 69 in level-3.