老年晚期癌症患者“优逝”模型的构建及死亡质量的实证研究

The incidence and mortality of cancer are seriously all over the world. It has become the first cause of human deaths. With the aging of the population increasing dramatically, the hospice care are play an important role in elderly patients of terminal cancer. In recent years, the research about good-death and quality of dying and death goes deeper and deeper, but the high individualization and dynamism calls for testing and cross-culture adaption in order to be appropriate for wider scope of population. The influence of culture concept, insufficient education, lacking of policy and investment from the nation and others reasons lead to huge gap between traditional filial piety and hospice care. The result of our team’s preliminary experiment has proven that the quality of dying and death of patients suffered from terminal cancer need to be improved and the death education is in urgent demand. But how to carry out the good-death and increase the quality of dying and death in dying patients still needs further researching. The project aims to do local culture adjustment adaption based on foreign good -death model and form a good-death model suitable for traditional Chinese culture, education background, patients’ and families’ need. Furthermore, we will do empirical research using this model among elderly patients suffered from terminal cancer. This study would be of great importance in the further illustration of the concept of good -death and revealing the rule of death. In addition, this study will provide theoretical basis and practical support for the further development of palliative care in China and has a bright prospect for clinical application.

全球癌症发病形势严峻，已成为导致人类死亡的第一诱因，日益严重的老龄化，使得老年癌症患者的临终护理愈发重要。近年来，对优逝和死亡质量的研究不断深入，但其高度的个体化和动态化的特点，使得更大范围的适用人群仍需检验和进行文化调试。文化观念影响、培训不足、国家层面政策支持及投入相对不足等原因导致传统孝道与现代临终关怀的融合仍存在巨大的鸿沟。研究团队的预实验结果也证实老年晚期肿瘤患者死亡质量亟待提高，对死亡教育有迫切需求， 但如何进行“优逝”教育，提高临终患者死亡质量，还有待进一步研究。本申请项目拟通过对国外的“优逝”模型进行本土化调适，形成符合中国社会文化、教育背景、患者和家属个体需求的“优逝”模型，并将此“优逝”模型在老年晚期癌症患者中进行实证研究。本课题的开展将对进一步阐明“优逝”概念，揭示死亡规律有重要意义，为推动姑息护理在国内的进一步开展提供理论依据和实践支撑，具有很好的临床应用前景。

人口老龄化现状的加剧，使得老年癌症患者的临终护理愈发重要，“优逝”已成为衡量现代临终关怀质量的核心指标。把“优逝”相关理论和中国实际相结合，积极推进安宁疗护开展，构建符合我国社会文化、教育背景、患者和家属个体需求的“优逝”模型，探索晚期肿瘤患者在综合医院和社区卫生机构、家庭的转介服务和联动机制，建立符合中国文化、教育背景、个体需求的安宁疗护模式，让晚期肿瘤患者在生命最后阶段有尊严的平静的离世，不仅是晚期肿瘤患者的基本人权，更体现了社会文明的进步以及国家和医疗机构对患者全方位的照护和支持。. 本研究在理论层面和实证层面进行了相关研究并对省、市卫健委、老龄委、学会等部门推动安宁疗护工作提供相应建议并取得了较好的效果。具体包括：调查了医务人员、患者对于“优逝”的认知和现况。完成了基于Web of science死亡质量领域的文献计量与可视化分析。开展了居家安宁疗护对晚期癌症患者生活质量影响的系统评价。进行了(QODD)濒死和死亡调查问卷中文版的汉化和修订。形成了综合医院安宁疗护服务流程和临终服务对象安宁疗护标准化服务实务操作手册。构建了多学科协作的安宁疗护服务模式并在晚期肿瘤患者中进行实证研究。拓展了机构社会资源，初步搭建了南京市安宁疗护服务资源平台，建立了临终患者的转介服务机制、梳理总结安宁疗护的专业服务标准。. 项目组通过学术会议交流、论文发表、出版著作、申请专利、基层推广、社区宣讲、政策提议等途径将本项目的主要研究成果进行推广应用，得到了广大患者和家属以及安宁疗护的从业人员的一致认可，为推动安宁疗护在国内的进一步开展提供了理论依据和实践支撑。