目的 构建家庭共同决策模式下危重症患者预立医疗照护计划沟通方案,为预立医疗照护计划在危重症患者中的推广提供参考依据。方法 通过文献查阅、半结构访谈构建家庭共同决策模式下危重症患者预立医疗照护计划沟通方案初稿。采用德尔菲法进行专家咨询,确定方案最终内容。结果 共开展2轮专家函询,2轮函询问卷有效回收率分别为91.30%、80.95%,专家权威系数分别为0.788、0.776,肯德尔和谐系数分别为0.184、0.110（均P<0.001）。最终构建的方案包括一级条目3项、二级条目11项、三级条目40项。结论 该研究构建的家庭共同决策模式下危重症患者预立医疗照护计划沟通方案具有可靠性、适用性,可为预立医疗照护计划在危重症患者中的开展提供指导。
Objective To construct the communication plan of advance care planning for critically ill patients under the family co-decision model,and to provide reference for the promotion of advance care planning in critically ill patients. Methods Through literature review and semi-structured interview,the first draft of the communication plan of advance care planning for critically ill patients under the family co-decision model was constructed. Delphi method was adopted for expert consultation to determine the final contents of the plan. Results A total of two rounds of expert consultations were conducted. The effective recovery rates of the questionnaires in the two rounds were 91.30% and 80.95%,the authority coefficients were 0.788 and 0.776,and the Kendall harmony coefficients were 0.184 and 0.110,respectively. Finally,the communication plan included 3 items of first level,11 items of second level and 40 items of third level. Conclusion The communication plan of advance care planning for critically ill patients under the family co-decision model established in this study is reliable and applicable,and can provide some guidance for the implementation of advance care planning for critically ill patients.
[1] 邓仁丽,王守碧,张江辉,等. 中西文化视野下预立医疗照护计划在医疗卫生体系中的植入[J]. 中国护理管理,2019,19(3):321-325.
Deng RL,Wang SB,Zhang JH,et al.To embed Advance Care Planning into the health care system in China in the vision of Chinese and western culture[J]. Chin Nurs Manag,2019,19(3):321-325.
[2] 万林,施素华,孔悦,等. 危重患者院内转运的研究进展[J]. 中华护理杂志,2016,51(8):975-978.
Wan L,Shi SH,Kong Y,et al.Research progress on transportation of critical patients[J]. Chin J Nurs,2016,51(8):975-978.
[3] Petrinec AB,Martin BR.Post-intensive care syndrome symptoms and health-related quality of life in family decision-makers of critically ill patients[J]. Palliat Support Care,2018,16(6):719-724.
[4] 黄瑞兵,许湘华,刘华云,等. 终末期肝病患者安宁疗护的研究进展[J]. 中华急危重症护理杂志,2021,2(6):557-560.
Huang RB,Xu XH,Liu HY,et al.Research progress of hospice care for patients with end-stage liver disease[J]. Chin J Emerg Crit Care Nurs,2021,2(6):557-560.
[5] 李子芬,彭楚君. 推动“以家庭为中心”的预立医疗照护计划[J]. 中国护理管理,2019,19(3):326-329.
Li ZF,Peng CJ.Promoting family-centered advance care planning in China[J]. Chin Nurs Manag,2019,19(3):326-329.
[6] 姬燕慧,刘瑞云,马亚楠. 以家庭为中心的全面发育落后患儿家庭照护者健康教育方案的构建[J]. 护理研究,2022,36(14):2445-2453.
Ji YH,Liu RY,Ma YN.Construction of family-centered health education plan for family caregivers of children with global developmental delay[J]. Chin Nurs Res,2022,36(14):2445-2453.
[7] 王心茹,朱信雨,贾玉玲,等. 文化因素对安宁疗护实践影响的质性研究[J]. 中华护理杂志,2023,58(13):1552-1558.
Wang XR,Zhu XY,Jia YL,et al.A qualitative study on the specificity of cultural factors in palliative care practice[J]. Chin J Nurs,2023,58(13):1552-1558.
[8] 国家卫生健康委. 国家卫生健康委关于印发《全国护理事业发展规划(2021-2025)》的通知[EB/OL].（2022-04-29)[2024-01-18]. http://www.nhc.gov.cn/yzygj/s7653pd/202205/441f75ad347b4ed68a7d2f2972f78e67.shtml.
National Health Commission. Notice of the National Health Commission on the issuance of the National Nursing Develop-ment Plan(2021-2025).（2022-04-29)[2024-01-18]. http://www.nhc.gov.cn/yzygj/s7653pd/202205/441f75ad347b4ed68a7d2f2972f78e67.shtml.
[9] 国家卫生健康委办公厅. 国家卫生健康委办公厅关于开展第三批安宁疗护试点工作的通知[EB/OL].（2023-07-12)[2024-01-18]. http://www.nhc.gov.cn/lljks/tggg/202307/df326ed6049249c7bf823df1395c9b4f.shtml.
General Office of the National Health Commission. Notice of the General Office of the National Health Commission on carrying out the third batch of hospice care pilot work[EB/OL].（2023-07-12)[2024-01-18]. http://www.nhc.gov.cn/lljks/tggg/202307/df326ed6049249c7bf823df1395c9b4f.shtml.
[10] 丁欣芸,刘学盛,霍原. 预立医疗照护计划持续性社会支持体系的构建[J]. 中国医学伦理学,2023,36(2):136-140,147.
Ding XY,Liu XS,Huo Y.Construction of sustained social support system for advance care plan[J]. Chin Med Ethics,2023,36(2):136-140,147.
[11] Popovich JJ,Budnick I,Neville TH.Time-limited trials of intensive care unit care[J]. JAMA Intern Med,2023,183(4):360-361.
[12] Chang DW,Neville TH,Parrish J,et al.Evaluation of time-limited trials among critically ill patients with advanced medical illnesses and reduction of nonbeneficial ICU treatments[J]. JAMA Intern Med,2021,181(6):786-794.
[13] 郑红玲,谌永毅,成琴琴,等. 终末期患者预立医疗照护计划中沟通模式的研究进展[J]. 中国护理管理,2021,21(1):145-150.
Zheng HL,Chen YY,Cheng QQ,et al.Research progress on communication model in advance care planning of end-of-life patients[J]. Chin Nurs Manag,2021,21(1):145-150.
