| ObjectiveThe purpose of this study was to explore the status of palliative care needs in patients with chronic kidney disease（CKD）stage 3 to 5,analyzed its influencing factors,and deeply explore the unmet needs of patients with CKD stage 3 to 5 and its influencing factors,as to provide theoretical support for medical staff to formulate palliative care intervention measures for patients with CKD,provide reference for the construction of palliative care service system,improve and expand the benefit level of palliative care services,then promote the quality of life of patient.MethodsThis study used a mixed method.The first part was quantitative research,the second part was qualitative research:（1）Quantitative research: Based on the cross-sectional study method,we selected313 patients with CKD stage 3 to 5 who were hospitalized or received dialysis treatment in the nephrology Department or dialysis center of a grade III Class A hospital in Lanzhou,Gansu Province from December 2020 to September 2021 by convenience sampling method,and then finished each questionnaire.The research tools included the general information questionnaire,Palliative Care Outcome Scale,Self-Perceived Burden Scale,Hospital Anxiety and Depression Scale,Karnofsky Performance Status.Epi Data3.1 was used to input research data,and Excel and SPSS26.0 were used to sort out and analyze data.The statistical methods were used frequency,percentage,mean ±standard deviation,independent sample t test,variance analysis,rank sum test,Pearson correlation analysis,multiple linear regression analysis.（2）Qualitative research: Based on the descriptive phenomenological analysis method,we selected 11 patients with CKD stage 3 to 5 whose palliative care outcome scale score was higher than（22.7±5.87）in the quantitative study from October 2021 to December 2021.Patients were selected for face-to-face semi-structured interviews by purpose sampling method,who were volunteered to participate in this study.Using the researcher himself as the research tool,the research data’s transition and analysis were used Nvivo 11.0 software and the Colaizzi seven-step analysis method.Result（1）Quantitative research: A total of 313 participants were collected in this study,with a recovery rate of 98.4%,including 202 males and 111 females,and the average age was（58.0±14.8）years.Description analysis showed that the total score of palliative care needs in patients with CKD stage 3 to 5 was（22.7±5.87）,the nursing quality dimension was（7.49±2.45）,the psychological and quality of life dimension was（15.21±4.33）.The total score of self-perceived burden was（29.27±6.00）,the emotional burden dimension was（17.53±3.76）,the economic burden dimension was（5.87±1.62）,and the physical burden dimension was（5.86±1.50）.The total score of anxiety and depression was（20.92±3.90）,and the score of anxiety was（10.87±2.32）,the score of depression was（10.05±2.61）;The average score of physical condition was（62.62±15.26）.Univariate analysis data showed that religion,years of illness,multimorbidity,the number of hospitalizations has significantly different with palliative care needs in patients with CKD stage 3 to 5（P<0.05）.Pearson correlation data analysis showed that self-perceived burden（r=0.24）,anxiety（r=0.24）,depression（r=0.14）and patients’ physical condition（r=0.25）were positively correlated with palliative care needs of patients with advanced CKD stage 3 to 5（P<0.05）.Multiple linear regression analysis data showed that religion,multimorbidity,the number of hospitalizations,self-perceived burden,depression,physical condition had significantly different with palliative care needs in patients with CKD stage 3 to 5（P<0.05）.（2）Qualitative research: A total of 11 patients with CKD stage 3 to 5 were interviewed in this study,numbered k1-K11 in sequence.Among them,8 were male and 3 were female.The mean age was（54±17.0）years.The results of theme analysis mainly include 2 themes and 7 sub-themes.The first topic is unmet needs of patients,and the sub-topics are disease-related needs（symptom relief,disease knowledge）,selfcare ability needs,communication needs（medical staff and patients communication,family members and patients’ communication）,social support needs（economic support,community/home continuing care）.The second topic is the influencing factors of patients’ unmet needs,and the sub-topics are disease factors,patients’ own factors（heavy psychological burden,lack of disease knowledge,high economic burden）,social factors（problems of hospital management,epidemic normalization）.Conclusion（1）The current level of palliative care needs of patients with CKD stage 3 to 5 is high,and the unmet needs of patients mainly include: disease symptom relief and knowledge needs;need for self-care ability;communicate needs with family members and medical staff;social economic support and community/home continuing care needs.（2）There are many influencing factors for palliative care needs of patients with CKD stage 3 to 5: among general data,patients with CKD stage 3 to 5 with heavy psychological burden（self-perceived burden）,poorer disease knowledge,heavy economic burden and without religion have higher demand for palliative care.Among disease-related factors,patients with CKD stage 3 to 5 who had more than 5comorbidities and were hospitalized 2～4 times per year had higher demand for palliative care.Among social factors,problems of hospital management and the normalization of epidemic situation have hindered the meeting of palliative care needs of patients with CKD stage 3 to 5. |
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