A Qualitative Research On The Acceptance Of My Five Wishes Of Elderly Patients'

Objective:The methods of quantitative research and qualitative research were used to understand the cognition and acceptance of "my five wishes" in elderly patients,and to analyze the related influencing factors,so as to provide a basis for promoting Advance directives clinical intervention.Methods:This study is divided into two parts: current situation investigation and qualitative research.Investigation on the current situation: after consulting the literature at home and abroad,consulting the hospice care experts and discussing in the study group,the questionnaire was selected and the reliability and validity of the questionnaire were measured.By using the convenient sampling method,174 elderly patients from two general hospitals were selected as subjects,and the general data questionnaire and "my five wishes" questionnaire were used as research tools to carry out the investigation,and the data were tested by z test and one-way analysis of variance.Multivariate analysis was used to understand the acceptance of "my five wishes" in elderly patients by multiple stepwise regression.Qualitative research: using the method of phenomenological research,referring to the results of the previous questionnaire,consulting the literature and discussion in the study group,making an interview outline,using the purpose sampling method to select the most representative 12 elderly patients for in-depth interviews.The facial expressions,intonation and body movements of the interviewees were recorded and recorded on the spot.The data were transcribed within 24 hours after the interview,and the interview data were analyzed in detail by Colaizzi seven-step analysis.To explore the in-depth feelings of elderly patients with advance instructions.Results:1.The current situation investigation: a total of 174 questionnaires were sent out and170 were collected.The effective recovery rate was 97.7%.The acceptance score of "my five wishes" questionnaire was 3.39 ± 0.44,and the score in the five parts of the questionnaire was more than 3 points.It shows that elderly patients are willing to participate in pre-directed discussions and support the "my five wishes" document.Through the repeated reading,analysis,classification and extraction of the interview materials,four topics are summarized:(1)the "my five wishes" document can fully reflect their own wishes;(2)it is difficult for families to accept;(3)doctors,patients and their families lack communication;and(4)it cannot really be implemented.2.Influencing factors: different age,education level,past occupation,average income,source of income,mode of medical insurance,rescue experience,frequency of hospitalization and whether they have heard of advance directives are the five wishes of elderly patients."factors affecting the acceptance of documents,The difference was statistically significant(P< 0.05).The statistically significant influencing factors in the results of univariate analysis were included in the multivariate stepwise regression analysis.Among them,the number of hospitalization,education,type of medical insurance and age can jointly explain the variation of 25.9% of the acceptance score of " I want or do not want any medical service " in the questionnaire of " my five wishes ".Per capita monthly income,rescue experience,occupation and age can jointly explain the variation in the score of 18.9% of the second wish," I want to use or not to use life support therapy ".Rescue experience,per capita monthly income and education explained 13.6% of the total variation in the third wish," what do I want others to do to me? ";financial resources,rescue experience and the number of hospitalization explained to " I want my family and.Friends know what "score 20.6% variation;" Rescue experience can predict4.1% of the variation in acceptance of "who I want to help me".3.Qualitative study: finally,an in-depth interview was conducted with 12 elderly patients.After repeated reading,analysis,classification and extraction of the interview data,Four themes are summarized:(1)the document "my five wishes" can fully reflecttheir wishes;(2)it is difficult for family members to accept;(3)there is a lack of communication among doctors,patients and their families;(4)it can not be really implemented.The results of qualitative studies show that patients' physical health status,traditional concepts,family factors and understanding of Advance directives can affect their acceptance of Advance directives and "my five wishes" documents.Conclusion:1.Elderly patients do not contradict the "my five wishes" document,the degree of acceptance is higher,the attitude is more positive,but all parties have more concerns,it is more difficult to take substantive action.2.The results of qualitative interviews suggest the possibility of further promoting Advance directives in China.It is suggested that we should start with improving the people's awareness of Advance directives and popularizing the correct concept of life and death,and gradually improve the relevant laws and regulations.Multi-disciplinary cooperation and team guidance to further promote the development of Advance directives.