目的 了解医学生对缓和医疗的认知程度,并对可能的影响因素进行分析。方法 采用问卷调查方法。采用自制问卷对参加2014年和2015年北京协和医院夏令营的全国33所医学院校的430名医学生进行调查。调查内容包括医学生基本信息、死亡态度、缓和医疗相关知识等。采用相关分析和秩和检验对医学生缓和医疗认知程度的影响因素进行分析。结果 女性(34.05±2.00)分、本科学历(34.07±2.04)分和硕士研究生(34.11±2.11)分、来自于大家庭(34.15±1.57)分、接受过死亡教育或培训(34.34±1.81)分、参加过志愿活动(34.03±2.06)分、家中谈论死亡的氛围坦白开放(34.01±1.99)分、有探望或看护濒临死亡患者经历(34.11±2.00)分的医学生的缓和医疗认知得分较高。结论 医学生缓和医疗认知程度与其是否接受过死亡教育和是否有过死亡接触经历有密切关系,这为医学教育者未来利用有限资源给有需求的人群进行缓和医疗教育以及在临床工作中应用缓和医疗知识提供了参考。
Objective To explore the cognition of palliative care among medical students and analyze the correlative factors.Methods Students from different places were invited to do the home-based made questionnaire, questions include students' basic information, their attitudes toward death and knowledge about palliative care. Correlation analysis and rank sum test were used to analyze the influencing factors.Results The following medical students got a higher grade of cognition about palliative care: female(34.05±2.00), undergraduates candidates for masters (34.11±2.11), those postgraduates (34.07±2.04), those born in a large family (34.15±1.57), those had received education or training about death(34.34±1.81) and those had participated in voluntary activities(34.03±2.06). Also students in an atmosphere of talking about death at home is frank and open(34.01±1.99) and those had visited or cared for dying patients(34.11±2.00).Conclusions Medical students' cognition of palliative care varies because of personalexperience of death or education background which suggests that could supply palliative care education penetrating intoclinic practice.
[1] World Health Organization. WHO definition of palliative care[EB/OL]. (2015-04-10) [2018-05-24]. http://www.who.int/cancer/palliative/definition/en/.
[2] Brooksbank M. Palliative care: Where have we come from and where are we going?[J]. Pain, 2009, 144(3):233-235.
[3] Smith TK, Temin S, Alesi ER, et al. American Society of Clinical Oncology provisional clinical opinion: The integration of palliative care into standard oncology care[J]. J Clin Oncology, 2012, 30(8):880-887.
[4] Temel JS, Greer JA, Muzikansy A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer[J].N Engl J Med, 2010,363(8):733-741.
[5] 医政医管局.国家卫生计生委办公厅关于印发安宁疗护实践指南(试行)的通知[EB/OL].(2017-02-09)[2018-05-24]. http://www.moh.gov.cn/yzygj/s3593/201702/83797c0261a94781b158dbd76666b717.shtml
[6] Fox E, Landrum-Meniff K, Zhong Z, et a1. Evaluation of prognostic criteria for determining hospice eligibility in patients with advanced lung, heart or liver disease[J]. JAMA, 1999, 282 (17) : 1638-1645.
[7] Temel JS, Jackson VA, Billings JA, et a1. Phase II study: Integrated palliative care in newly diagnosed advanced non-small-cell lung cancer patients[J]. J ClinOncol,2007, 25(17) : 2377-2382.
[8] 张杰, 彭琰, 王治仁, 等. 中日两国医学院校医学专业老年临终关怀教育的比较[J].中国老年学杂志,2010,30(6):818-820. DOI: 10.3969/j.issn.1005-9202.2010.06.039.
[9] 李欣. 台湾地区高校生命教育课程探析及启示[D]. 武汉:湖北大学,2014.
[10] Dickinson GE. Thirty-five years of end-of-life issues in US medical schools[J]. Am J Hosp Palliat Med, 2011,28(6):412-417.
[11] Fraser HC, Kutner JS, Pfeifer MP. Senior medical students' perceptions of the adequacy of education on end-of-life issues[J]. J Palliat Med, 2001, 4(3):337-343.
[12] Billings ME, Engelbert R, Curtis JR, et al. Determinants of medical students' perceived preparation to perform end-of-life care, quality of end-of-life care education and attitudes toward end-of-life care[J]. J Palliat Med, 2010, 13(3):319-326.
[13] Anderson WG, Williams BS, Bost JE, et al. Exposure to death is associated with positive attitudes and higher knowledge about end-of-life care in graduating medical students[J]. J Palliat Med, 2008,11(9):1227-1233.
[14] Bickel-Swenson D. End-of-life training in U.S. medical schools: A systematic literature review[J]. J Palliat Med, 2007, 10(1):229-235.
[15] Sullivan AM, Warren AG, Lakoma MD, et al. End-of-life care in the curriculum: A national study of medical education deans[J]. Acad Med, 2004, 79(8):760-768.
[16] Charon R. Narrative medicine: Form, function, and ethics[J]. Ann Intern Med,2001, 134(1):83-87.
[17] Horowitz R, Gramling R, Quill T. Palliative care education in US medical schools[J]. Med Educ, 2014, 48(1):59-66.
