癌症患者临终沟通障碍现状、影响因素分析及护理启示 [中文引用][英文引用]

目的 探讨癌症患者临终沟通障碍现状，分析其影响因素，为临床医护人员实施家庭干预提供理论依据。方法 本研究为横断面研究，采用方便抽样法，选取 2022 年 12 月— 2023 年 5 月本市 3 所三级甲等综合医院的 354 例癌症患者，使用一般资料问卷、中文版临终沟通障碍 - 家庭版量表（difficulties in end of life discussions-family inventory，DEOLD-FI）、家庭功能评定量表（family assessment device，FAD）和中文版癌症自我管理效能感量表（strategies used by people to promote health，SUPPH）对其进行调查。采用方差分析、独立样本 t 检验、Pearson 相关分析进行单因素分析；采用多重线性回归分析癌症患者临终沟通障碍的影响因素。结果 320 例癌症患者完成研究。癌症患者临终沟通障碍得分为（76.5±16.0）分，处于中等水平。多重线性回归分析显示，年龄越大者、自我管理效能感越高者、家庭功能越好者其临终沟通障碍越低，合并 3 种及以上基础疾病者其临终沟通障碍最低。结论 癌症患者临终沟通障碍处于中等水平，医护人员应针对原因，通过家庭、医院和社工等多方合作，降低癌症患者的临终沟通障碍水平。

Objective To investigate current situation and the factors influencing end-of-life communications in families having cancer patients in order to provide advices for family intervention. Methods In this cross-sectional study, convenience sampling method was used to select 354 cancer patients from three Tier-IIIA hospitals in Shiyan between December 2022 and May 2023. Data were collected using a general data questionnaire, the difficulties in end-of-life discussions-family inventory（DEOLD-FI）, family assessment device（FAD）, and the Chinese version of the strategies used by people to promote health（SUPPH）scale . Univariate analysis included analysis of variance, independent sample t-test, and Pearson correlation analysis. Multiple linear regression identified the factors associated with end-of-life communication difficulty with cancer patients. Results A total of 320 cancer patients completed the study. The score of end-of-life communication with cancer patients was（76.5±16.0）at medium level. Multiple linear regression analysis revealed that individuals who were older, had higher self-management efficacy, and had better family functioning experienced lower barriers to end-of-life communication. Those with three or more comorbidities experienced the lowest barriers to end-of-life communication. Conclusion This study has found that there is a moderate end-of-life communication difficulty with cancer patients. Medical professionals should focus on these reasons and organize multidisciplinary collaboration with families, hospitals and social workers is essential to address the challenges.