Objective This study aims to describe the preference for primary healthcare (PHC) and investigate associated factors among homebound residents in both rural and urban areas of China. It provides valuable insights to facilitate the rational allocation of healthcare resources and promote the utilization of PHC. Methods In this nationally representative cross-sectional study, we utilized the most recent data (2020) from the China Family Panel Studies (CFPS). Participants were recruited from 25 provincial-level administrative regions in both rural and urban areas of China. Homebound patients were asked to provide details about their individual characteristics, variables related to family caregiving, and preferences for PHC. Multivariable logistic models were used to analyze potential factors associated with preference for PHC. Estimates of association were reported as odds ratios (OR) and their 95% confidence intervals (CI). Results The study found that 58.43% of rural patients reported a preference for PHC, while 42.78% of urban patients favored PHC. Compared to rural participants who did not received inpatient care in the past year, those who received inpatient care in the past year had 67% lower odds of choosing PHC (OR:0.33, 95% CI:0.19–0.59); Compared to rural participants who did not received family caregiving when ill, those who received family caregiving when ill had 59% lower odds of choosing PHC (OR: 0.41, 95% CI:0.21–0.77). Correspondingly, Compared to urban participants who did not received inpatient care in the past year, those who had received inpatient care in the past year had 75% lower odds of choosing PHC (OR: 0.25, 95% CI: 0.10–0.56); Compared to urban participants who did not received family caregiving when ill, those who received family caregiving when ill had 73% lower odds of choosing PHC (OR: 0.27, 95% CI: 0.11–0.63); Compared to urban participants who with agricultural Hukou, those with Non-agricultural Hukou had 61% lower odds of choosing PHC (OR: 0.39, 95% CI:0.18–0.83); Compared to urban participants living in the eastern part of mainland China, those living in the central part of China had 188% higher odds of choosing PHC (OR: 2.88, 95% CI: 1.14–7.29). Conclusion Policymakers should focus on tailoring PHC to vulnerable populations and prioritizing family-based public health strategies for enhancing homebound patients’ perceptions of PHC. Furthermore, further study is needed on whether the Hukou registration system affects the barriers that homebound patients experience in choosing healthcare providers.

BACKGROUND:An aging population has contributed to an increasing prevalence of functional limitations among older adults. Family support plays a crucial role in toileting and bathing assistance. Yet, the relationship between availability of family care resources and such actual assistance remains insufficiently explored. Our study aims to describe availability of family care resources and identify the association between availability of family care resources and toileting assistance or bathing assistance.METHODS:This study employed a cross-sectional analysis of data from the 2018 National Survey of the China Health and Retirement Longitudinal Study (CHARLS). The availability of family care resources was assessed using measurements of spouse availability, adult child availability, and living arrangement. Bathing assistance and toileting assistance were measured based on self-reported receipt of such assistance. Descriptive statistics were used to depict the overall and subgroup situation of availability of family care resources. Multivariable logistic models were employed to investigate the relationship between availability of family care resources and the receipt of toileting assistance or bathing assistance.RESULTS:Among the sample of older adults with functional limitations, 69% had a spouse, 63% had at least one adult child, and 80% resided with family members. Among those with bathing disability, 13% reported lacking bathing assistance, and among those with toileting disability, 54% reported lacking toileting assistance. Participants with 1-2 adult children had lower odds of receiving toileting assistance (OR: 0.28, 95% CI: 0.09, 0.91, p= 0.034) compared to those with three or more adult children. Spouse availability and living arrangement did not exhibit statistically significant associations with toileting assistance. Participants without a spouse had lower odds of receiving bathing assistance (OR: 0.27, 95% CI: 0.09-0.78, p= 0.016) in comparison to those with a spouse; however, adult child availability and living arrangement did not display statistically significant associations with bathing assistance.CONCLUSION:The present findings suggest a gap in family commitment when it comes to assisting older adults with functional limitations in bathing/toileting. To address this, policymakers are encouraged to prioritize the implementation of proactive mechanisms for identifying family caregivers, alongside incentives to enhance their engagement in practical caregiving activities. Furthermore, it is crucial to emphasize the prioritization of affordable and easily accessible formal toileting/bathing assistance options for older adults who lack sufficient family care resources.

The aim of this study was to assess the factors associated with primary healthcare (PHC) utilization among older adults with functional limitations, providing insights for improving the effectiveness of PHC for this population. We used the China Health and Retirement Longitudinal Study (CHARLS) dataset, which encompasses 28 provinces in China. Logistic regression was used to analyze the people-related, care context-related, and linkage-related factors associated with PHC utilization. Approximately 55.61% of older adults with functional limitations utilized PHC in the past month, regardless of visit frequency or extent. Participants with lower educational attainment, those reporting more pain, and those living in rural areas had a higher likelihood of PHC utilization. Participants who received inpatient care in the past year had a lower likelihood of PHC utilization. We recommend that policymakers complement existing PHC health programs with increased health and social welfare support for this population.

BackgroundLoneliness is one of the major health problems among older adults. Among this population, home and community-based services (HCBS) have become increasingly popular. Despite its health benefits, little is known about the relationship between HCBS use and loneliness in older people with functional limitations. We aim to explore the characteristics of loneliness among older people with functional limitations and examine the association between HCBS use and loneliness in China.MethodsWe used a cross-sectional data from the 2018 China Health and Retirement Longitudinal Study, which includes a nationally representative sample of Chinese residents aged 65 and older with functional limitations. Logistic regression models were used to examine the associations between HCBS use and loneliness, and we further used propensity score matching to address potential sample selection bias.ResultIn China, 46% of older people with functional limitations felt lonely and only 22% of older people with functional limitations reported using HCBS in 2018. Compared with participants who did not receive HCBS, those who received HCBS were less likely to report loneliness (OR = 0.81, 95% CI = 0.63, 0.99, p = 0.048), and the results remained significant after addressing sample selection bias using propensity score matching.ConclusionOur results showed that loneliness was common among Chinese older people with functional limitations, and the proportion of HCBS use was low. There was robust evidence to support that among older people with functional limitations, HCBS use was associated with decreased loneliness. Further policies should promote the development of broader HCBS use for older people with functional limitations to reduce their loneliness.

Objective:To systematically review the qualitative research on the treatment decision-making of elderly cancer patients,so as to provide references for improving the quality of life of patients.Methods:This study searched nine literature data-bases,including PubMed,Web of Science,CNKI and so on from inception to December 31,2022 and collected qualitative studies with the theme of treatment decision-making of elderly cancer patients.The 2016 version of the Joanna Briggs Institute's critical ap-praisal tool for qualitative studies in Australia was used to evaluate the quality of the literature.Meta-synthesis was applied to in-tegrate research results.Results:A total of 13 articles were included and summarized into 3 integration results.The decision-mak-ing modes of elderly cancer patients'preferences included orientation of patients,doctors and nurses,family members and sharing of multiple subjects.The factors that affected the decision-making of elderly cancer patients mainly included patient characteristics,medical supply status and so on.There were individual differences in the attitude of elderly cancer patients towards information see-king,and they preferred to collect practical information,probability information and professional information of doctors through self-study or seeking help from others.Conclusion:The treatment decisions of elderly cancer patients arise from specific social and cultural backgrounds.Physical function and quality of life are the core treatment demands of patients.The quality of decision infor-mation directly affects the final decision.

BACKGROUND:Hospital facilities in China are experiencing increased strain on existing systems and medical resources, necessitating the use of home-based hospice and palliative care (HBHPC). HBHPC primarily relies on community nurses and related medical personnel. Understanding the challenges that community nurses face when providing this form of care is urgently needed to optimize the design and delivery of HBHPC. Our study aimed to gain insight into community nurses' challenges when providing HBHPC for patients.METHODS:We performed a descriptive qualitative study using a phenomenology approach. Purposive sampling was used to recruit 13 nurses from two community health service centers in Jinan, Shandong Province, China. A thematic analysis was applied to identify themes from the transcribed data.RESULTS:Three major themes emerged: 1) Community nurses' inadequate self-preparation for providing HBHPC; 2) Patients and their families' non-collaboration in HBHPC; 3) Community health service career disadvantages. Many negative experiences can be attributed to institutional barriers.CONCLUSION:Community nurses faced multifaceted challenges in home care settings. This study could provide a framework for guiding the improvement of interventional variables in the provision of HBHPC. Future research should involve developing effective methods of improving community nurses' job motivation and community health service institutions' incentive systems, as well as increasing advocacy around HBHPC.

Abstract Background Chinese clinical nurses are increasingly confronting patient death, as the proportion of hospital deaths is growing. Witnessing patient suffering and death is stressful, and failure to cope with this challenge may result in decreased well-being of nurses and impediment of the provision of “good death” care for patients and their families. To our knowledge, few studies have specifically explored clinical nurses’ experiences coping with patient death in mainland China. Objective We aimed to explore nurses’ experiences coping with patient death in China in order to support frontline clinical nurses effectively and guide the government in improving hospice care policy. Methods Clinical nurses were recruited using purposive and snowball sampling between June 2020 and August 2020. We gathered experiences of clinical nurses who have coped with patient death using face-to-face, semi-structured, in-depth interviews. Audio recordings were transcribed verbatim and analyzed using thematic analysis. Results Three thematic categories were generated from data analysis. The first was “negative emotions from contextual challenges.” This category involved grief over deaths of younger persons, pity for deaths without family, and dread related to coping with patient death on night duty. The second category was “awareness of mortality on its own.” Subthemes included the ideas that death means that everything stops being and good living is important because we all die and disappear. The third category was “coping style.” This category included focusing on treating dying patients, recording the signs and symptoms, and responding to changes in the patient’s condition. It also involved subthemes such as avoiding talk about death due to the grief associated with dying and death, and seeking help from colleagues. Conclusions Clinical nurses’ emotional experiences are shaped by intense Chinese filial love, charity, and cultural attitudes towards death. Reasonable nurse scheduling to ensure patient and staff safety is a major priority. “Good death” decisions based on Chinese ethical and moral beliefs must be embedded throughout hospital care.

Despite oncology providers’ significant roles in patient care, few studies have been conducted to investigate oncology providers’ understanding of financial toxicity. This study aimed to explore oncology providers’ perceptions and practices relating to the financial toxicity of older cancer survivors in China. A qualitative study was conducted. Individual interviews were conducted with 14 oncology providers at four general hospitals and two cancer specialist hospitals in China. Qualitative data was analyzed using descriptive coding and thematic analysis methods. The perceptions of participants about the financial toxicity of older cancer survivors include (1) older adults with cancer are especially vulnerable to financial toxicity; (2) inadequate social support may lead to financial toxicity; and (3) cancer-related financial toxicity increased the risk of poor treatment outcomes. The interventions to mitigate its negative effects include (1) effective communication about the cancer-related costs; (2) improving the professional ability to care for the patient; (3) cancer education program as a way to reduce knowledge gaps; and (4) clinical empathy as an effective treatment strategy. Oncology providers perceive that older cancer patients’ financial toxicity plays a key role in increasing the negative effects of diagnosis and treatment of cancer, as well as possibly worsening cancer outcomes. Some potential practices of providers to mitigate financial toxicity include utilizing effective cost communication, improving professional ability in geriatric oncology care, and promoting further cancer education and clinical empathy.

BACKGROUND:Mobile health (mHealth) apps have shown the advantages of improving medication compliance, saving time required for diagnosis and treatment, reducing medical expenses, etc. The World Health Organization (WHO) has recommended that mHealth apps should be evaluated prior to their implementation to ensure their accuracy in data analysis.OBJECTIVE:This study aimed to translate the patient version of the interactive mHealth app usability questionnaire (MAUQ) into Chinese, and to conduct cross-cultural adaptation and reliability and validity tests.METHODS:The Brislin's translation model was used in this study. The cross-cultural adaptation was performed according to experts' comments and the results of prediction test. The convenience sampling method was utilized to investigate 346 patients who used the "Good Doctor" ("Good Doctor" is the most popular mHealth app in China), and the reliability and validity of the questionnaire were evaluated as well.RESULTS:After translation and cross-cultural adaptation, there were a total of 21 items and 3 dimensions: usability and satisfaction (8 items), system information arrangement (6 items), and efficiency (7 items). The content validity index was determined to be 0.952, indicating that the 21 items used to evaluate the usability of the Chinese version of the MAUQ were well correlated. The Cronbach's α coefficient of the total questionnaire was 0.912, which revealed that the questionnaire had a high internal consistency. The values of test-retest reliability and split-half reliability of the Chinese version of the MAUQ were 0.869 and 0.701, respectively, representing that the questionnaire had a good stability.CONCLUSION:The translated questionnaire has good reliability and validity in the context of Chinese culture, and it could be used as a usability testing tool for the patient version of interactive mHealth apps.

目的:本文旨在构建我国临床护士死亡应对能力继续教育课程方案,为护士死亡应对能力继续教育工作提供指导和参考.方法:首先,对临床护士进行访谈,归纳护士死亡应对过程中的挑战与需求,作为课程方案构建的原型;其次,通过文献回顾进一步探究课程方案具体目标与内容,形成课程草案;最后,运用德尔菲专家函询法确立课程方案目标与内容.结果:形成的课程有18个课程目标、10个一级标题、57个二级标题,课程目标和课程内容的协调系数分别为0.235(P<0.001)和0.138(P<0.001),各项课程目标和课程内容重要程度得分均大于3.5,表示课程目标与内容条目均较为重要.结论:本研究通过多种研究方法,构建实用、符合临床情境需求、科学、可靠的死亡应对能力继续教育课程方案,可为护士死亡应对能力继续教育工作提供参考依据.

目的 探讨肿瘤科医护人员缓和医疗知识与态度的现状及其影响因素.方法 采用整群抽样法于2019年7～9月对山东大学齐鲁医院肿瘤中心和山东省肿瘤医院278名医护人员进行缓和医疗知识问卷(PCQN)和照顾临终患者态度量表(C-FATCOD)的问卷调查.结果 肿瘤科医护人员缓和医疗知识总分为(11.72±2.98)分,姑息护理哲理与原则维度得分最低,正确率为42.75％,肿瘤科医护人员缓和医疗态度总分(104.37±11.83)分;不同人口学特征的肿瘤科医护人员其知识得分差异无统计学意义(P>0.05);不同年龄、科室、职称医护人员的态度维度得分差异有统计学意义(P<0.05);不同知识维度中心理社会精神支持得分医护人员的态度维度得分差异有统计学意义(P<0.05);多元线性回归分析结果显示,科室肿瘤内科、高级职称、知识维度心理社会精神支持高分组均为影响医护人员缓和医疗态度的重要因素(P=0.047,P=0.006,P=0.015).结论 肿瘤科医护人员缓和医疗知识掌握情况欠佳,照护态度积极性评分不高,管理者应加强对肿瘤科医护人员的缓和医疗知识的培训和态度积极性的培养.

Nursing staff plays a crucial role in the end-stage of a patient′s life, and it is inevitable for nursing staff to face and handle problems about death. The ability to cope with death is of vital importance, which can reduce the risk of emotional distress in nurses, and assist nurses to better participate in patients' end-stage care, and improve the quality of care. This paper summarizes the definition, components, theoretical frameworks and models, assessment tools, status quo, influencing factors of the coping with death competence, and propose the corresponding intervention strategy according to the situation of our country, provide references for the future research.

目的 系统评价护士发生用药错误的体验,为管理者制订完善的用药错误管理体系,构建医疗安全不良事件护士支持项目提供理论依据.方法 计算机检索中国生物医学文献数据库、中国知网、维普、万方、乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证卫生保健中心图书馆、考克兰循证医学图书馆、PubMed、EMbase、Web ofScience、EBSCO、CINAHL Complete、PsycINFO及opengrey数据库,检索时限均为从建库至2019年6月30日,收集护士发生用药错误体验的质性研究,采用英国牛津循证医学中心文献质量评价项目进行文章质量评价,采用主题综合法对结果进行整合.结果 共纳入11项研究,提炼31个研究结果,归纳形成10个新类别,整合形成3大核心主题.①情绪情感体验:多数护士表现消极情感体验,渴望得到他人包括患者、家属及同事的支持和理解,有力的帮助和支持可减少护士负面情绪;②医疗应对体验:护士能及时采取相应措施避免或降低伤害,但向患者或家属的告知意愿和主动上报事件的意愿较低;③职业影响体验:用药错误事件对护士职业产生正性或负性影响.结论 用药错误给护士带来较大的心理应激,患方的理解以及同事、家属的支持会帮助其积极应对错误事件,促进患者用药安全.

Objective To systematic evaluate the real experience of patients after falling during hospitalization and qualitative research on the cognition and demand for fall prevention will provide theoretical basis for patients, their families, medical staff and medical institutions to better carry out fall prevention. Methods English databases such as PsycINFO, Medline, Embase, CINAHL, Cochrane, PubMed, and Chinese databases such as Chinese biomedical literature database, CNKI, Wanang database were retrieved by computer. Included qualitative studies on the emotional experience of fall of inpatients and their cognition and needs for fall prevention. The retrieval time limit was until November 1, 2018.The literature was evaluated using the quality evaluation criteria for qualitative research (2016) of the JBI evidence-based health care center, and the results were integrated using a pooled integration method. Results A total of 8 studies were included, and 33 clear research results were extracted. Similar results were summarized and combined to form 7 new categories, which were integrated into 4 results. Results 1:psychological experience of hospitalized patients after falling down. Integration results 2: the causes of falls from the perspective of inpatients. Integration results 3: hospital fall prevention measures and evaluation from the perspective of inpatients. Integration result 4: inpatients expected to receive care from their families and help from medical staff. Conclusion Fall events seriously affect the mental health of patients; Patients′cognition of falling is affected and changed by many factors. Fall prevention should shift from clinical focus to patient-centered and attach importance to the participation of family members.

本文对社会角色视域下的优逝期望进行综述,分别对优逝的内涵,优逝的构成要素,以及终末期患者、患者家庭照顾者、医务人员对优逝的期望与观点进行回顾与总结.本研究致力于为临床工作者制定相关护理干预措施提供参考,为我国安宁疗护事业的进一步发展提供理论依据.

目的 系统评价慢性病终末期患者优逝期望与需求的质性研究.方法 计算机检索PubMed、Embase、Web of Science、PsycINFO、Cochrane Library、中国知网、万方数据库、中国生物医学文献数据库中从建库至2019年3月31日相关的质性研究.采用澳大利亚JBI循证卫生保健中心质性研究质性评价标准进行文献质量评价,采用汇集性整合方法对研究结果进行归纳整合.结果 共纳入14篇文献,提炼出52个结果,归纳出10个新的类别,综合为4个整合结果:生理需求(临终阶段的生理需求、死亡时的生理需求);心理需求(满足愿望、积极心理);精神需求(宗教信仰、维持尊严、其他精神需求);社会需求(人际关系、经济层面、支持系统).结论 慢性病终末期患者的优逝期望与需求涉及生理、心理、精神、社会多个方面,具有个性化、主观性、贯穿终末期全过程的特点,不同方面的期望与需求可能发生重叠并相互影响.医护人员应加强对慢性病终末期患者优逝期望与需求的关注,提供全人、全程的个体化护理服务,普及公众对优逝理念的认识.社会资源及卫生政策应进一步支持安宁疗护事业,共同协助终末期患者实现优逝的愿望.