| ObjectiveAiming at "the limited utilization of palliative care for hospitalized patients with advanced liver cancer",this project explores the barriers to the services at the patient-level.Based on the view that patients’ knowledge of health services promotes the use of health services,the research group first systematically searched major databases at home and abroad based on evidence-based concepts.On the basis of understanding the cognitive status and influencing factors of palliative care of adult cancer patients at home and abroad,a questionnaire was developed.The Chinese-version Perceptions of Palliative Care Instrument investigated the palliative care cognition of patients with advanced liver cancer,analyzed the key factors affecting their cognitive level,and provided references for similar studies,so as to advance the concept of palliative care and promote the early intervention of palliative care.MethodsThis study is divided into three parts:1.The mixed methods systematic review of palliative care perception of adult cancer patients is based on evidence-based conceptAccording to the literature classification criteria,major databases at home and abroad were systematically searched.Back-to-back literature quality evaluation was carried out on the screened and included studies.Data integration was carried out according to the mixed methods systematic review in the JBI Evidence Integration Manual.2.Chinesization of Perceptions of Palliative Care InstrumentAfter the original scale of Perceptions of Palliative Care Instrument was authorized to be Chinese,based on the Brislin translation model,the scale was introduced through the procedures of "literal translation,back translation,pre-survey,cross-cultural adaptation".Convenience sampling method was adopted to select the hospitalized patients with advanced liver cancer who met the inclusion and exclusion criteria in our hospital from June 2022 to December 2022 as the study objects,and the reliability and validity of the scale was tested through item analysis,internal consistency evaluation,retest reliability,structural validity and content validity.3.Investigation on the current situation and influencing factors of perceptions of palliative care of patients with advanced liver cancerThe method of convenience sampling was adopted.Inpatients with advanced liver cancer who met the inclusion and exclusion criteria in our hospital from June 2022 to December 2022 were selected as the research objects.Combined with the Chinese version of the Perceptions of Palliative Care Instrument,the Edmonton Symptom Assessment System and the Cancer Coping and Management Questionnaire,the current situation of the patients’ palliative care cognition was investigated to understand the current situation of the advanced liver cancer inpatients’,palliative care perception,and the correlation between each factor and each dimension and total item of PPCI was analyzed.Results1.Mixed Mothods Systematic Review of Palliative Care Cognition in Adult Cancer Patients17 studies were included in this study,including 13 quantitative studies,2 qualitative studies,and 2 mixed studies.The study design was mainly cross-sectional,with a total of13 studies,2 using mixed methods,1 exploratory phenomenology,and 1 grounded theory.The literature quality was above grade B,and a total of eight results were obtained after the integration of 17 studies.Most of the researchers used self-made questionnaires as evaluation tool for palliative care cognitive assessment.Cancer patients have a limited understanding of palliative care,and most of them learn about palliative care from medical staff,family and friends.The influencing factors include gender,education,income,age,occupation,seeking cancer-related information,and health self-rating score and so on.2.The reliability and validity of the Chinese-version Perceptions of Palliative Care InstrumentThe reliability and validity of the Chinese-version Perceptions of Palliative Care Instrument were all high,and the item analysis showed good differentiation of each item.The Cronbach’s a coefficient of the total scale was 0.840,and the odd-even half-reliability was 0.618.Cronbach’s a coefficient of each dimension ranged from 0.830 to 0.935,and KMO value was 0.827(>0.8),8 common factors were extracted,and the cumulative contribution rate of variance was 72.924%(>40%),chi-square degree of freedom ratio of confirmatory factor analysis(χ2/Df=1.848)(<3),the relative fit index(RFI)was 0.798,the comparative fit index(CFI)was 0.907(>0.9),value added fitting index(IFI)was 0.909(> 0.9).3.Investigation on cognition of palliative care in patients with advanced liver cancer and its Influencing factorsAmong the 234 participants,73.9% had never heard of palliative care,and their emotional reaction to palliative care was more positive.They felt that they would receive more support from palliative care,and that their lives were less disrupted or helpless.The need for palliative care was generally high.The perceived burden was heavy.The readiness to understand palliative care was not high.Univariate and multivariate analyses showed that The influencing factors of each dimension and total item score of palliative care perception in patients with advanced liver cancer included gender,occupation,economic pressure,medical payment method,treatments,time of cancer diagnosis,self-rated health status,whether there were minor children,knowledge levels of palliative care,religious belief,symptoms(nausea,anxiety,shortness of breath,other symptoms,sleepiness,resignation,appetite)and cancer coping style(vent,avoid and suppress,face,yield).Among them,confrontation and mild shortness of breath significantly negatively predicted negative emotional responses,and female gender,high economic pressure,mild nausea,avoidance and depression significantly positively predicted negative emotional responses.Moderate/severe anorexia and cancer diagnosis time more than one year can significantly positively predict the cognitive response to palliative care support.Having religious belief had a negative impact on actual demand,and self-rated general/poor and moderate/severe poor appetite had a positive impact on actual demand.Mild nausea and general/poor self-rated health status can positively predict burden perception.An increase in confrontation score and an increase in resignation score positively predicted readiness to learn palliative care.Palliative care attitude items were significantly correlated with some dimensions and total item of PPCI(P<0.05).Conclusions1.Based on the evidence-based concept and taking adult cancer patients as research objects,a mixed method systematic review was conducted to screen out the influencing factors of palliative care cognition of adult cancer patients;2.Through the standard Chinesization process,Perceptions of Palliative Care Instrument with good reliability and validity was obtained,which can be used to investigate the current status of palliative care cognition of people with different diseases;3.There are many factors affecting the cognition of palliative care in patients with advanced liver cancer,and these specific population are the preferred group of palliative care cognition intervention and the key group of IDT service.The single item of Palliative Care Attitude can replace the PPCI for cognitive rough selection to some extent. |
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