为家庭访视护士制定终末期讨论启动的量表
Developing a Scale for Home-Visit Nurses to Start End-of-life Discussions with Cancer Patients
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影响因子:3.5
分区:医学2区 / 临床神经病学2区 卫生保健与服务2区 医学：内科2区
发表日期:2025 Jan
作者:
Kurumi Asaumi, Masataka Oki, Wataru Ohashi
DOI:
10.1016/j.jpainsymman.2024.09.003
摘要
家庭访视护士在确定何时适合与癌症患者开始终末期讨论方面面临挑战。本研究旨在开发“终末期讨论时机（T-EOLD）”量表，以帮助家庭访视护士判断何时开始终末期讨论，并测试其可靠性和效度。量表条目基于访谈、文献综述和专家小组讨论中的定性数据而制定。我们进行了一项初步研究，涉及93名家庭访视护士，评估了量表的结构效度、一致性和重测信度。最后，利用234名家庭访视护士的样本，进行了主要研究，评估了结构效度和量表一致性。最初开发了41个条目。通过初步和主要研究中的地板效应、项-总相关、良-差分析和探索性因子分析，形成了一个三因子、16条目的模型。模型的拟合优度为CFI=0.94，GFI=0.90，AGFI=0.87，RMSEA=0.06。量表的Cronbach’s α为0.91。T-EOLD的信度和效度均可接受，是家庭访视护士用以判断何时启动终末期讨论的合适工具。然而，仍需进一步研究其在国内外的临床实用性。
Abstract
Home-visit nurses find it challenging to determine the appropriate time to initiate end-of-life discussions with cancer patients.This study aimed to develop the Timing of End-of-Life Discussions (T-EOLD) scale to help home-visit nurses determine the appropriate time to initiate end-of-life discussions with cancer patients and to test its reliability and validity.The scale items were developed based on qualitative data extracted from interviews, literature reviews, and expert panel discussions. We conducted a preliminary study involving 93 home-visit nurses and evaluated the construct validity, consistency, and test-retest reliability of the scale. Finally, using a sample of 234 home-visit nurses, we conducted the primary study and assessed the construct validity and scale consistency.A total of 41 items were initially developed. Floor effect, item-total correlation, good-poor, and exploratory factor analysis in the preliminary and primary studies yielded a three-factor, 16-item model. The model's goodness-of-fit was CFI = 0.94, GFI = 0.90, AGFI = 0.87, and RMSEA = 0.06. Cronbach's alpha for the overall scale was 0.91.The reliability and validity of the T-EOLD is acceptable, as it is an appropriate scale that home-visit nurses can use to determine the time to initiate end-of-life discussions with cancer patients. However, further study is required to examine T-EOLD's clinical utility, both nationally and internationally.