上海交通大学学报(医学版) ›› 2024, Vol. 44 ›› Issue (4): 482-493.doi: 10.3969/j.issn.1674-8115.2024.04.009

• 论著 · 循证医学 • 上一篇    

晚期癌症患者预立医疗照护计划参与行为影响因素的系统综述

傅艺玲(), 吴茜, 罗晓庆, 吴艾泓, 夏雪兰, 郑敏()   

  1. 重庆医科大学附属第二医院呼吸与危重症医学科,重庆 400010
  • 收稿日期:2023-11-01 接受日期:2024-02-06 出版日期:2024-04-28 发布日期:2024-04-28
  • 通讯作者: 郑敏 E-mail:1715757154@qq.com;1287285766@qq.com
  • 作者简介:傅艺玲(1999—),女,护士,硕士生;电子信箱:1715757154@qq.com

Factors influencing advance care planning engagement behavior in patients with advanced cancer: a systematic review

FU Yiling(), WU Qian, LUO Xiaoqing, WU Aihong, XIA Xuelan, ZHENG Min()   

  1. Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
  • Received:2023-11-01 Accepted:2024-02-06 Online:2024-04-28 Published:2024-04-28
  • Contact: ZHENG Min E-mail:1715757154@qq.com;1287285766@qq.com

摘要:

目的·系统整合晚期癌症患者预立医疗照护计划(advance care planning,ACP)参与行为的相关影响因素。方法·系统检索中国知网、万方、中国生物医学文献数据库(Sinomed)、PubMed、Cochrane Library、Embase、CINAHL、PsycINFO等数据库从建库至2022年12月有关晚期癌症患者ACP参与行为影响因素的中英文文献。由2名研究者对最终纳入的文献进行文献质量评价、内容提取和汇总,将定量研究与定性研究分别提取数据后进行整合,得到晚期癌症患者ACP参与行为的最终影响因素。并借助理论域框架,将其逐级映射至能力、机会、动机-行为(capability, opportunity, motivation-behavior,COM-B)模型。结果·共纳入21项研究,整合归纳出27个影响因素,涉及9个理论域。映射至COM-B模型中的因素包括能力因素9个(ACP知识、文化程度、准确了解预后知识、知晓疾病诊断时间、先前经历、主观预期寿命、年龄、肿瘤部位、疾病症状负担)、机会因素13个(性别、婚姻状况、种族/民族、宗教信仰、未成年子女、家庭经济收入、居住地点、房屋居住类型、家庭支持、社会支持、医患关系、文化适应、是否设立临终关怀服务中心)和动机因素5个(ACP态度、ACP信念、ACP动机、焦虑抑郁、死亡态度)。其中,医患关系、宗教信仰、ACP态度、文化程度、婚姻状况、家庭支持、ACP知识、准确了解预后知识、年龄、居住地点、死亡态度、先前经历、种族/民族是对患者ACP参与行为影响较多的因素。结论·基于COM-B模型可全面归纳总结晚期癌症患者ACP参与行为的影响因素。未来研究可以上述因素为切入点,基于COM-B模型设计连续化、多方面的综合性干预措施,促进晚期癌症患者ACP参与行为实践。

关键词: 预立医疗照护计划, 癌症, 晚期, COM-B模型, 影响因素, 系统综述

Abstract:

Objective ·To systematically integrate relevant influencing factors of advanced cancer patients' engagement behavior in advance care planning (ACP). Methods ·The systematic search of Chinese and English literature on factors influencing ACP engagement behavior in advanced cancer patients from inception to December 2022 in China National Knowledge Infrastructure (CNKI), Wanfang, China Biomedical Literature Database (Sinomed), PubMed, Cochrane Library, Embase, CINAHL, and PsycINFO was conducted. After the literature quality evaluation, content extraction and summary were conducted by two researchers, and the data of quantitative research and qualitative research were extracted and integrated respectively. The final influencing factors of ACP engagement behavior of advanced cancer patients were obtained. With the help of the theoretical domain, they were mapped to the capability, opportunity, motivation-behavior (COM-B) model step by step. Results ·A total of 21 studies were included and 27 factors were summarized, including 9 theoretical domains. Mapping to the COM-B model included 9 capability factors (knowledge of ACP, education level, accurate knowledge of prognosis, knowledge of the time of disease diagnosis, prior experience, subjective life expectancy, age, cancer site, and disease symptom burden), 13 opportunity factors (gender, marital status, race/ethnicity, religious belief, dependent children, family economic condition, place of living, housing type, family support, social support, doctor-patient relationship, acculturation, and whether or not to establish a hospice service center) and 5 motivational factors (ACP attitude, ACP belief, ACP motivation, anxiety and depression, and death attitude). Among them, doctor-patient relationship, religious belief, ACP attitude, educational level, marital status, family support, knowledge of ACP, accurate knowledge of prognosis, age, place of living, attitude toward death, prior experience, and race/ethnicity were more influential factors on ACP engagement behavior. Conclusion ·Based on the COM-B model, the influencing factors of ACP engagement behavior in advanced cancer patients can be comprehensively summarized. Future studies can use the above factors as an entry point to design continuous, multifaceted, and comprehensive interventions based on the COM-B model to promote the practice of ACP engagement behavior in advanced cancer patients.

Key words: advance care planning, cancer, advanced, COM-B model, influencing factor, systematic review

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