|
|
Nursing Science 2025
维持性血液透析患者预立医疗照护计划研究进展
|
Abstract:
预立医疗照护计划能帮助具有决策能力的个体明确自己的价值观，思考严重疾病情况的意义和后果，确定未来医疗照护的目标与偏好，在一定程度上保障患者的医疗知情权和自主权，有助于提升患者的生存质量和节约社会医疗资源，这成为西方发达国家常规护理中的一部分。目前，预立医疗照护计划在国内尚处于起步阶段，针对终末期肾病并接受维持性血液透析的人群研究较少，且国内尚未将姑息治疗纳入血液透析常规治疗模式。本文系统综述对预立医疗照护计划在血液透析人群中的实践现状及影响因素进行描述与分析，并结合我国实际情况提出建议。
Advance care planning can help individuals with decision-making ability to clarify their own values, think about the significance and consequences of serious disease situations, determine future medical care goals and preferences, to a certain extent, protect the patient’s medical right to know and autonomy, and help to improve the quality of life of patients and save social medical resources. This becomes part of routine care in Western developed countries. At present, advance care planning is still in its infancy in China. There are few studies on the population of end-stage renal disease receiving maintenance hemodialysis, and palliative care has not been included in the routine hemodialysis treatment model in China. This article systematically reviews the practice status and influencing factors of advance care planning in hemodialysis population, and puts forward suggestions combined with the actual situation in China.
| [1] | Mori, M., Chan, H.Y.L., Lin, C., Kim, S., Ng Han Lip, R., Martina, D., et al. (2024) Definition and Recommendations of Advance Care Planning: A Delphi Study in Five Asian Sectors. Palliative Medicine, 39, 99-112. https://doi.org/10.1177/02692163241284088 |
| [2] | 窦俊凯, 杨亮, 刘欢, 等. 维持性血液透析患者透析后疲乏预测模型的构建及应用效果[J]. 护理实践与研究, 2023, 20(5): 658-664. |
| [3] | 饶茜, 曾兢, 李琴, 等. 维持性血液透析患者的慢性疼痛现状及生活质量研究[J]. 成都医学院学报, 2022, 17(2): 240-243+252. |
| [4] | 赵学谦, 刘宗瑞. 维持性血液透析患者治疗慢性肾脏病相关性瘙痒症的研究进展[J]. 中国中西医结合肾病杂志, 2024, 25(6): 563-564. |
| [5] | 肖雪, 施素华, 王培莉, 等. 维持性血液透析患者焦虑、抑郁与透析充分性的相关调查[J]. 中国中西医结合肾病杂志, 2021, 22(4): 321-322. |
| [6] | 邱瑛, 王静, 李雪芹. 维持性血液透析患者认知障碍现状调查及影响因素分析[J]. 中国中西医结合肾病杂志, 2021, 22(11): 1005-1008. |
| [7] | Houben, C.H.M., Spruit, M.A., Groenen, M.T.J., Wouters, E.F.M. and Janssen, D.J.A. (2014) Efficacy of Advance Care Planning: A Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association, 15, 477-489. https://doi.org/10.1016/j.jamda.2014.01.008 |
| [8] | Schmidt, R.J., Weaner, B.B. and Long, D. (2015) The Power of Advance Care Planning in Promoting Hospice and Out-of-Hospital Death in a Dialysis Unit. Journal of Palliative Medicine, 18, 62-66. |
| [9] | Johansen, K.L., Gilbertson, D.T., Li, S., et al. (2024) US Renal Data System 2023 Annual Data Report: Epidemiology of Kidney Disease in the United States. American Journal of Kidney Diseases, 83, A8-A13. |
| [10] | Saeed, F., Ladwig, S., Allen, R.J., et al. (2023) Racial Disparities in Health Beliefs and Advance Care Planning among Patients Receiving Maintenance Dialysis. Journal of Pain and Symptom Management, 65, 318-325. |
| [11] | Agunbiade, A., Dasgupta, A. and Ward, M.M. (2019) Racial/Ethnic Differences in Dialysis Discontinuation and Survival after Hospitalization for Serious Conditions among Patients on Maintenance Dialysis. Journal of the American Society of Nephrology, 31, 149-160. https://doi.org/10.1681/asn.2019020122 |
| [12] | Unruh, M., Miskulin, D., Yan, G., Hays, R.D., Benz, R., Kusek, J.W., et al. (2004) Racial Differences in Health-Related Quality of Life among Hemodialysis Patients. Kidney International, 65, 1482-1491. https://doi.org/10.1111/j.1523-1755.2004.00529.x |
| [13] | Brown, M.A., Collett, G.K., Josland, E.A., et al. (2015) CKD in Elderly Patients Managed without Dialysis: Survival, Symptoms, and Quality of Life. Clinical Journal of the American Society of Nephrology, 10, 260-268. |
| [14] | Morton, R.L., Webster, A.C., McGeechan, K., Howard, K., Murtagh, F.E.M., Gray, N.A., et al. (2016) Conservative Management and End-of-Life Care in an Australian Cohort with ESRD. Clinical Journal of the American Society of Nephrology, 11, 2195-2203. https://doi.org/10.2215/cjn.11861115 |
| [15] | 中华人民共和国香港特别行政区医务卫生局. 维持生命治疗的预作决定条例[EB/OL]. https://www.healthbureau.gov.hk/chs/press_and_publications/otherinfo/241110_adlto/index.html, 2024-11-20. |
| [16] | 赵宇飞, 赵素琴. 终末期肾病病人预立医疗照护计划研究进展[J]. 全科护理, 2019, 17(30): 3741-3744. |
| [17] | 李豪, 景孟娟, 徐榆林, 等. 预立医疗照护计划在血液透析患者中的应用研究[J]. 中华护理杂志, 2022, 57(6): 645-650. |
| [18] | Harrison Dening, K., Castle, E., Scates, C. and De Vries, K. (2019) Advance Care Plans in Dementia: User-Centred Design. BMJ Supportive & Palliative Care, 10, e38. https://doi.org/10.1136/bmjspcare-2018-001700 |
| [19] | Lupu, D., Quigley, L., Mehfoud, N., et al. (2018) The Growing Demand for Hospice and Palliative Medicine Physicians: Will the Supply Keep Up? Journal of Pain and Symptom Management, 55, 1216-1223. |
| [20] | 王守碧, 杨柳, 陈柳柳, 等. 护士在预立医疗照护计划中的角色定位[J]. 护理学杂志, 2019, 34(17): 94-97. |
| [21] | Rosenberg, K. (2021) Nurse-Led Intervention Increases Advance Care Planning Discussions and Documentation. American Journal of Nursing, 121, 47-48. https://doi.org/10.1097/01.naj.0000742516.16715.55 |
| [22] | Ohr, S.O., Cleasby, P., Jeong, S.Y., et al. (2021) Nurse-Led Normalized Advance Care Planning Service in Hospital and Community Health Settings: A Qualitative Study. BMC Palliative Care, 20, Article No. 139. |
| [23] | Walczak, A., Butow, P.N., Tattersall, M.H.N., Davidson, P.M., Young, J., Epstein, R.M., et al. (2017) Encouraging Early Discussion of Life Expectancy and End-of-Life Care: A Randomized Controlled Trial of a Nurse-Led Communication Support Program for Patients and Caregivers. International Journal of Nursing Studies, 67, 31-40. https://doi.org/10.1016/j.ijnurstu.2016.10.008 |
| [24] | Pattison, M. and Romer, A.L. (2001) Improving Care through the End of Life: Launching a Primary Care Clinic-Based Program. Journal of Palliative Medicine, 4, 249-254. https://doi.org/10.1089/109662101750290335 |
| [25] | Amro, O.W., Ramasamy, M., Strom, J.A., et al. (2016) Nephrologist-Facilitated Advance Care Planning for Hemodialysis Patients: A Quality Improvement Project. American Journal of Kidney Diseases, 68, 103-109. |
| [26] | Axelsson, L., Benzein, E., Lindberg, J. and Persson, C. (2019) End-of-Life and Palliative Care of Patients on Maintenance Hemodialysis Treatment: A Focus Group Study. BMC Palliative Care, 18, Article No. 89. https://doi.org/10.1186/s12904-019-0481-y |
| [27] | Maddalena, V., O’Shea, F. and Barrett, B. (2017) An Exploration of Palliative Care Needs of People with End-Stage Renal Disease on Dialysis. Journal of Palliative Care, 33, 19-25. https://doi.org/10.1177/0825859717747340 |
| [28] | Kataoka-Yahiro, M.R., Conde, F.A., Wong, R.S., Page, V. and Peller, B. (2010) Advance Care Planning among Asian Americans and Native Hawaiians Receiving Haemodialysis. International Journal of Palliative Nursing, 16, 32-40. https://doi.org/10.12968/ijpn.2010.16.1.46181 |
| [29] | Goff, S.L., Unruh, M.L., Klingensmith, J., Eneanya, N.D., Garvey, C., Germain, M.J., et al. (2019) Advance Care Planning with Patients on Hemodialysis: An Implementation Study. BMC Palliative Care, 18, Article No. 64. https://doi.org/10.1186/s12904-019-0437-2 |
| [30] | Song, M., Happ, M.B. and Sandelowski, M. (2010) Development of a Tool to Assess Fidelity to a Psycho-Educational Intervention. Journal of Advanced Nursing, 66, 673-682. https://doi.org/10.1111/j.1365-2648.2009.05216.x |
| [31] | 商君婷, 赵军亚, 陈燕, 等. 代理决策者参与预立医疗照护计划的研究进展[J]. 军事护理, 2024, 41(11): 95-98. |
| [32] | 张馨, 姬艳博, 张秋悦, 等. 护士进行预立医疗照护计划实践体验质性研究的Meta整合[J]. 中国实用护理杂志, 2023, 39(20): 1594-1601. |
| [33] | 杨雪梅, 梁湘, 陈思芮, 等. 预立医疗照护计划准备度研究进展[J]. 护理研究, 2024, 38(5): 837-842. |
| [34] | 成文武, 王丽英. 预立医疗照护计划在我国实施的可行性探讨[J]. 医学与哲学, 2020, 41(22): 15-20. |
| [35] | 吴前胜, 徐灵, 徐蓉, 等. 国内医务人员对生前预嘱的认知研究进展[J]. 护理研究, 2019, 33(15): 2626-2628. |
| [36] | 陈俊冶, 王梓瑜, 张嘉鑫, 等. 生命的终点: 论预立医疗照护计划开展的可行性及策略探讨[J]. 卫生软科学, 2024, 38(6): 43-47. |
| [37] | 宋莉娟, 袁长蓉. 医学院校死亡教育课程的开展现状与启示[J]. 护理学杂志, 2021, 36(16): 106-110. |
| [38] | 刘英, 张小红, 王莎, 等. 基于“千聊live”的死亡教育培训对急诊科护士临终关怀态度和死亡态度的影响[J]. 护理研究, 2023, 37(5): 922-925. |
| [39] | Liu, X., Chen, H., Zhang, L., Zhang, Q., Feng, T. and Liu, D. (2022) Advance Care Planning Engagement among Family Members of Community-Dwelling Elderly Patients with Chronic Diseases in China. Journal of Hospice & Palliative Nursing, 24, E26-E34. https://doi.org/10.1097/njh.0000000000000829 |
| [40] | 倪钦敏, 谭秋, 沈芳, 等. 死亡教育在我国癌症患者中应用效果的系统评价[J]. 广西医学, 2023, 45(17): 2127-2133. |
| [41] | 谭夙辉, 张慧琳, 陈太春, 等. 医护人员参与预立医疗照护计划沟通体验的Meta整合[J]. 护理学杂志, 2025, 40(3): 97-102. |
| [42] | 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. |
| [43] | 陈裕丽, 郑宝宝, 巫家强, 等. 预立医疗照护计划在香港地区的临床实践及过程评价[J]. 中国护理管理, 2019, 19(3): 330-333. |
