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Cognition of Palliative Care and Experience of Palliative Sedation in Chinese Anesthesiologists: A National Cross-sectional Survey
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摘要: 目的 初步调查我国麻醉医师对缓和医疗及终末期患者缓和镇静的了解及相关临床能力。 方法 2021年10月—12月，采用便利抽样法，通过中华医学会麻醉学分会在全国麻醉医师中开展横断面问卷调查。问卷内容主要包括社会人口学信息、工作经验、是否熟悉缓和医疗、面对终末期患者的感受、是否给重症/终末期痛苦患者实施过缓和镇静及镇静药物选择。 结果 来自全国29个省级行政单位的2536名麻醉医师完成了有效问卷，其中仅572名（22.6%，572/2536）医师表示熟悉缓和医疗。有重症/终末期患者接触经历、参与疼痛临床诊疗、医院设立安宁缓和医疗组或相应部门/组织的麻醉医师中熟悉缓和医疗的比例更高。超过40%的麻醉医师面对终末期患者时会感到无力、无助且对临床决策存在困惑，了解缓和医疗的麻醉医师面对重症/终末期患者时信心更足（9.8%比4.4%，P=0.001）。在734名有缓和镇静实施经验的麻醉医师中，151人（20.6%，151/734）曾仅使用阿片类药物作为镇静手段。 结论 我国麻醉医师对缓和医疗及缓和镇静药物选择的认识均不足。加强缓和医疗团队建设、开展缓和医疗及缓和镇静的教育培训或将有助于提高麻醉医师面对重症/终末期患者时的信心，改善终末期患者的诊疗质量。Abstract: Objective This study aimed to investigate the understanding of palliative care and experience of palliative sedation for end-stage patients in Chinese anesthesiologists. Methods From October to December 2021, a national cross-sectional survey was conducted among anesthesiologists in China distributed by the Chinese Society of Anesthesiology, Chinese Medical Association with convenient sampling. The questionnaire in this study included general information, working experience, familiarity with palliative care, feelings with end-stage cases, experience in sedation for critical/end-stage patients and choice of medication. Results A total of 2536 anesthesiologists from 29 provinces in China completed valid questionnaires. 572 (22.6%, 572/2536) reported that they were familiar with palliative medicine. Anesthesiologists who had experience in critical/end-stage patients care, pain management, and whose hospitals set up with institutional palliative care team reported more familiarity with palliative care. Over 40% of anesthesiologists felt powerless, helpless, and undecisive when facing end-stage patients. Anesthesiologists with knowledge of palliative care were more likely to show confidence in their management of critical/end-stage patients (9.8% vs 4.4%, P = 0.001). 734 anesthesiologists had experience of conducting sedation in end-stage patients, among whom 151 anesthesiologists (20.6%, 151/734) improperly used opioids as the only medication in sedation protocol. Conclusion The understanding of palliative care and palliative sedation medication choice among anesthesiologists in China was still very limited. Development of palliative care team, education and training on palliative care may help to build the confidence of anesthesiologists when facing critical/end-stage patients and to improve the quality of care in end-stage patients.
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Key words:
- palliative care /
- palliative sedation /
- opioid /
- anesthesiologist
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