CAJ | 학술논문

目的：了解医务人员对恶性肿瘤末期患者安宁自然死的态度和行为倾向。方法采用偶遇调查法，于2012年8月对广东省人民医院、东莞市人民医院、石龙人民医院、广东医学院附属医院和广东农垦医院等肿瘤科以及与肿瘤治疗相关科室206名医务人员进行调查。问卷内容主要包括医务人员基本情况（包括性别、年龄、工作类型、职称、学历、工作年限和工作科室），对恶性肿瘤末期患者采取的治疗方式，采取的治疗方式主要是基于什么（多项选择题），对恶性肿瘤末期患者治疗的态度，对我国是否推进安宁自然死的认识，对推进安宁自然死的最大障碍认识，对安宁自然死的了解程度，对推广安宁自然死的方式等。结果共发放调查问卷206份，回收206份，回收率为100.0%；有效问卷198份，有效率为96.1%。60.1%（119/198）的医务人员对恶性肿瘤末期患者倾向采取安宁治疗，36.9%（73/198）的医务人员实际采取安宁治疗；医务人员采取的治疗方式是患者或其家属的要求占75.8%（150/198）；医务人员认为患者应对症治疗，减轻痛苦的占86.0%（170/198）；医务人员认为我国推进安宁自然死很有必要和有必要的占66.2%（131/198）；医务人员认为推进安宁自然死的最大障碍是国家政策或法律缺乏明确的可操作性规范，容易引发医疗纠纷的占57.1%（113/198）；医务人员了解安宁自然死的占19.7%（39/198）。结论医务人员对安宁自然死的了解率较低，需要对医务人员大力加强安宁自然死专业知识的教育和培训，以及在全社会加强安宁自然死相关知识的宣传和教育，需要转变肿瘤科医务人员对末期患者的诊疗观念等。
목적：료해의무인원대악성종류말기환자안저자연사적태도화행위경향。방법채용우우조사법，우2012년8월대광동성인민의원、동완시인민의원、석룡인민의원、엄동의학원부속의원화엄동농은의원등종류과이급여종류치료상관과실206명의무인원진행조사。문권내용주요포괄의무인원기본정황（포괄성별、년령、공작류형、직칭、학력、공작년한화공작과실），대악성종류말기환자채취적치료방식，채취적치료방식주요시기우십요（다항선택제），대악성종류말기환자치료적태도，대아국시부추진안저자연사적인식，대추진안저자연사적최대장애인식，대안저자연사적료해정도，대추엄안저자연사적방식등。결과공발방조사문권206빈，회수206빈，회수솔위100.0%；유효문권198빈，유효솔위96.1%。60.1%（119/198）적의무인원대악성종류말기환자경향채취안저치료，36.9%（73/198）적의무인원실제채취안저치료；의무인원채취적치료방식시환자혹기가속적요구점75.8%（150/198）；의무인원인위환자응대증치료，감경통고적점86.0%（170/198）；의무인원인위아국추진안저자연사흔유필요화유필요적점66.2%（131/198）；의무인원인위추진안저자연사적최대장애시국가정책혹법률결핍명학적가조작성규범，용역인발의료규분적점57.1%（113/198）；의무인원료해안저자연사적점19.7%（39/198）。결론의무인원대안저자연사적료해솔교저，수요대의무인원대력가강안저자연사전업지식적교육화배훈，이급재전사회가강안저자연사상관지식적선전화교육，수요전변종류과의무인원대말기환자적진료관념등。
Objective To find out the medical personnel's attitude and conduct propensity to palliative and natural death of terminal malignant tumor patients. Methods Accidental sampling method was used to investigate 206 medical personnel in oncology or related departments from five hospitals:Guangdong Provincial People's Hospital,Dongguan Municipal People's Hospital,Shinglong People's Hospital,First Affiliated Hospital of Guangdong Medical University and Guangdong Agricultural Reclamation Hospital about their general information( gender,age,working types,professional title,academic credentials, length of service,and working department),the treatment methods they used for the terminal malignant tumor patients,the rea-sons for the treatment methods( multiple choice questions),their attitude toward the treatment,their viewpoint on palliative and natural death,the biggest barrier,their analysis of publicity methods,etc. Results 206 questionnaires were enrolled and 206 were returned with a rate of 100. 0%,among which 198 were valid with effective rate of 96. 1%. 60. 1%( 119/198 ) medical personnel say " yes" to the palliative treatment. 36. 9%( 73/198 ) had applied it. 75. 8%( 150/198 ) listened to the patients or relatives. 86. 0%(170/198) thought patients needed symptomatic treatment to relieve pain. 66. 2%(131/198) thought it was necessary or very necessary to popularize the palliative death. 57. 1%( 113/198 ) thought the biggest barrier to popularize palliative death was lack of clear policy or law specification and therefore was easy for medical disputes. 19. 7%( 39/198 ) had some knowledge of palliative death. Conclusion The knowledge rate on palliative death of medical personnel is lower. It is neces-sary to strengthen expertise education and training on the palliative and natural death in the medical personnel,as well as publici-ty and education about the related knowledge of natural and palliative death to the people. The medical personnel in oncology de-partment need change their treatment concept to the terminal malignant tumor patients.