ABSTRACT
Objective To explore the inclusion criteria of community-based palliative care service.Methods From July 2017 to September 2017,three rounds of Delphi consultation for development of inclusion criteria of community-based palliative care was conducted.With judgment sampling method,23 senior executives and managers from 6 pilot units of palliative care service in Shanghai were selected and invited to participate in the consultation,which included the importance,coercion and completeness of the inclusion criteria.According to the consulting results,the inclusion criteria of community palliative care services was developed.Results The median age of experts was 35 years (29-55 years,with a quartile spacing of 7 years).The average working experience of experts was (13.7 ± 7.5) years,in which that for palliative care was (4.1 ± 1.6) years.The authority coefficient was 0.82,and the Kendall coordination coefficient was 0.337 (P＜0.01) for the importance of inclusion criteria.In the developed criteria,the four mandatory inclusion criteria were patient needs,the provision ability of community health service centers,compliance with legal requirements and compliance with the concept of palliative care service;and the five non-mandatory inclusion criteria were heavy needs and demands,high cooperation from patients and their families,high satisfaction of patients and their families,within the scope of community health service centers and clinical guidelines for the operations.Conclusion The experts of this research have high enthusiasm and authority,and the developed inclusion criteria of community palliative care service contents are reasonable and feasible.This studymay provide reference for setting up the contents adjustment mechanism of community-based palliative service.
ABSTRACT
ObjectiveTo investigate the selection of dilivery of pregnant women and related factors.MethodsThe selection of delivery modes for pregnant women was investigated by analyzing the associated factors of the infants registered into a computerized health care managing system from January 1,2008 to December 31,2010 at a local community of Shanghai.The information associated with delivery modes of their mothers was collected and the choice of delivery modes investigated through a standardized questionnaire by interviewing the mothers at two months after birth.ResultsThe cesarean section (C/S)rate of pregnant women residing in this local area was 58.3 ％ (224/384).In the C/S group,the percentages of delivery age ≥24 yr,white-collar workers,education level at high school and above and monthly income ≥ 3000 yuan were 73.2％ ( 164/224 ),38.4％ ( 86/224 ),79.5％ ( 178/224 ) and 80.8％ ( 181/224 )respectively.And they were all higher than those of vaginal delivery (63.1％,n =101; 32.5％,n =52;69.4％,n =111; 70.6％,n =113 ).The choices of C/S depended on the existences of maternal,fetal,social-psychological and others factors during pregnancy.Most pregnant women and families who chose C/S without medical indications were afraid of pain ( 33.9％ ) or a failure of vaginal delivery ( 30.5％ ).ConclusionsThe social-psychological factors of pregnant women are important in the choices of delivery modes.Unnecessary C/S could be reduced by improving their knowledge of delivery with meticulous prenatal health care consultations.