CAJ | 학술논문

目的：了解上海市社区舒缓疗护（临终关怀）项目试点机构晚期恶性肿瘤临终住院患者的卫生服务需求。方法采用便利抽样法，选取于2014年3月6—20日在上海市18家临终关怀项目试点机构的临终关怀病房住院的晚期恶性肿瘤患者134名。采用自行设计的调查问卷，对患者进行问卷调查。问卷的主要内容包括患者的基本情况、生命质量情况、卫生服务需求、对疾病和死亡的态度。结果134名晚期恶性肿瘤临终住院患者中，123人（占91.8％）生活不能完全自理，86人（占64.2％）有疼痛；50人（占37.3％）选择积极治疗，仅17人（占12.7％）选择放弃或拒绝治疗，63人（占47.0％）有心理护理需求，18人（占13.4％）有心灵需求，69人（占51.5％）迫切需求家属陪伴，仅25人（占18.7％）对志愿者服务有需求；84人（占62.7％）知晓病情，82人（占61.2％）对疾病的态度听任自然，53人（占39.6％）不愿谈论死亡。不同年龄、信仰、地域、生命质量的患者卫生服务需求间差异有统计学意义（P＜0.05）。结论老年及高龄恶性肿瘤患者是社区临终关怀服务的主要对象，患者医疗护理需求较高，心理、精神方面需求未得到满足，期望得到亲友的支持。心理护理、生活护理、镇痛治疗应作为社区临终关怀服务的工作重点，应注重对患者的心理心灵关爱和死亡教育，鼓励家属亲友共同参与。
목적：료해상해시사구서완료호（림종관부）항목시점궤구만기악성종류림종주원환자적위생복무수구。방법채용편리추양법，선취우2014년3월6—20일재상해시18가림종관부항목시점궤구적림종관부병방주원적만기악성종류환자134명。채용자행설계적조사문권，대환자진행문권조사。문권적주요내용포괄환자적기본정황、생명질량정황、위생복무수구、대질병화사망적태도。결과134명만기악성종류림종주원환자중，123인（점91.8％）생활불능완전자리，86인（점64.2％）유동통；50인（점37.3％）선택적겁치료，부17인（점12.7％）선택방기혹거절치료，63인（점47.0％）유심리호리수구，18인（점13.4％）유심령수구，69인（점51.5％）박절수구가속배반，부25인（점18.7％）대지원자복무유수구；84인（점62.7％）지효병정，82인（점61.2％）대질병적태도은임자연，53인（점39.6％）불원담론사망。불동년령、신앙、지역、생명질량적환자위생복무수구간차이유통계학의의（P＜0.05）。결론노년급고령악성종류환자시사구림종관부복무적주요대상，환자의료호리수구교고，심리、정신방면수구미득도만족，기망득도친우적지지。심리호리、생활호리、진통치료응작위사구림종관부복무적공작중점，응주중대환자적심리심령관애화사망교육，고려가속친우공동삼여。
Objective To investigate the health service needs of terminal inpatients with advanced malignant tumor in community hospice care pilot settings in Shanghai .Methods Using convenience sampling method , we enrolled 134 terminal inpatients with advanced malignant tumor from 18 community hospice care pilot settings in Shanghai from March 6 to 20, 2014.We conducted self -designed questionnaire survey with the patients .The survey content included general data , quality of life, health service needs and attitudes toward disease and death .Results Of 134 terminal inpatients with advanced malignant tumor, 123 (91.8%) couldn′t make self -care, 86 (64.2%) had ache, 50 (37.3%) chose active treatment, only 17 (12.7%) gave up on or refused treatment , 63 ( 47.0%) had needs for psychological care ,, 18 ( 13.4%) had spiritual needs, 69 (51.5%) had urgent needs for relatives′company, only 25 (18.7%) had needs for volunteers′service, 84 (62.7%) knew about their illness condition, 82 (61.2%) let nature take its course, 53 (39.6%) were unwilling to talk about death.Patients with different ages , beliefs, quality of life and from different regions were significantly different in health service needs (P<0.05) .Gonclusion Old and aged patients with advanced cancer are the main service objects in community hospice care service .The terminal patients hold high -level need for medical and nursing care , their needs for psychological and spiritual care have not been met , and they long to get their family and friends′support.The community hospice care should focus on psychological care , life care and analgesic therapy .Psychological , spiritual care and death education for terminal patients should be attached importance , and patients′relatives and friends should be encouraged to be involved .