The Construction Of Palliative Care Program For Patients And Their Families In ICU

ObjectiveTo understand the needs of family members of patients with incurable diseases in ICU,to explore the views and suggestions of ICU medical staff on palliative care,and to preliminarily construct the palliative care program that embodies the characteristics of ICU specialties,thus provide guidance for the implementation and development of high-quality ICU palliative care in China.Methods1.Literature review:Using keywords to search the literature in the domestic and foreign databases,and searching documents and policies on palliative care published on official websites at home and abroad.After summarizing and sorting out the data,a palliative care program for patients and their families in ICU was initially developed.2.Questionnaire survey:A total of 240 family members of critical patients with incurable diseases in ICU were recruited by convenient sampling.General Status Questionnaire and Critical Care Family Needs Inventory(CCFNI)were used to assess the family members.So as to screen the items related to the program.3.Semi-structured interviews: Semi-structured interviews were conducted with 15 medical staff in ICU by objective sampling,and Colaizzi’s phenomenological method was used to analyze and extract the valuable narratives.In order to further improve the indicators of the program.4.Delphi method: 30 experts specialized from the related fields in 10 provinces and cities including Shandong,Jiangsu,Henan,Hubei,Liaoning,Beijing and so on were selected for two rounds of consultation.The inclusion criteria of each indicator is satisfying the mean value of importance assignment ≥ 4.0,coefficient of variation ≤ 0.25 and full score rate ≥20% simultaneously.We modify the items according to the experts’ opinion and the score.5.Statistical methods: Excel was used for data input,and SPSS25.0 was used for statistical analysis.The general information of the experts was described by the frequency and composition ratio.The enthusiasm of experts was expressed by the recovery rate of the questionnaire,the degree of expert authority was expressed by expert authority coefficient,and the Kendall’s W was used to describe the degree of coordination of experts’ opinion.The significance of indicators was expressed by mean,standard deviation and weight value.Results1.The results of literature review:Through the collation and analysis of relevant literature and documents,the framework and its subordinate indicators of ICU palliative care program were initially formed,including “establishing,evaluating,including,implementing and assessing”,etc.2.The results of Questionnaire survey: The CCFNI scores from high to low were as follows: condition guarantee(3.75±0.27),information acquisition(3.56±0.45),closeness to patients(3.55±0.38),supports from health-care professionals(2.88±0.44)and their own comfortable feeling(2.35±0.57).Among all the needs,“they can be informed immediately when the patient’s condition changes”ranked the top.3.The results of Semi-structured interviews: After the induction and analysis of interview data,four themes could be extracted: cognition of palliative care concept,implementation of palliative care,assessment of the needs of patients and their families,and strategies to develop the palliative care.4.The results of Delphi: A total of 26 experts across the country completed two rounds of consultation,the positive coefficient of experts was 86.67% and 100% respectively,the authority coefficient of experts was 0.88,and the coordination coefficient of experts’ opinion was 0.186 and 0.191 respectively.The final ICU palliative care program composed of 6first-level indicators,22 second-level indicators and 95 third-level indicators.5.In this study,the weights of the first-level indicators and the second-level indicators were calculated by proportion distribution method.The weights of the six first-level indicators were: building a palliative care team(0.1669),carrying out comprehensive evaluation(0.1596),including palliative care objects(0.1624),strengthening communication(0.1736),implementing palliative care(0.1750)and forming the system of evaluation(0.1624).Among them,the weight of “implementing palliative care” is the highest.ConclusionThis study reviewed the literature and was based on the results of questionnaires as well as semi-structured interviews.After two rounds of expert consultation,the palliative care program for patients and their families in ICU was finally constructed.The response rate,authority and coordination of the experts are high.The opinions of experts tend to be consistent,and the program constructed is certainly scientific and reliable,which is able to provide guidance for the implementation and development of high-quality palliative care in China.