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Article(id=1240375119986610767, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202311424, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1700582400000, receivedDateStr=2023-11-22, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658073659, onlineDateStr=2026-03-16, pubDate=1711296000000, pubDateStr=2024-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658073659, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658073659, creator=13701087609, updateTime=1773658073659, updator=13701087609, issue=Issue{id=1240375105386238038, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658070179, creator=13701087609, updateTime=1773658539618, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377074414833974, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377074414833975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=994, endPage=997, ext={EN=ArticleExt(id=1240375120330543726, articleId=1240375119986610767, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Measurement methods of quality-adjusted life years for advanced cancer patients, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

Quality of life and survival time are important contents of palliative care services for patients with advanced cancer. Therefore, investigating the measurement method of quality-adjusted life years for patients with advanced cancer could provide a basis for the evaluation of palliative care services for this population.

Methods

The relative importance of each index in the Quality-of-Life Scale of Cancer Patients was compared by expert consultation method and hierarchical analysis was used to obtain the weight of each index.

Results

In the Quality-of-Life Scale of Cancer Patients, the weights of primary indicators from high to low included physical symptoms, mental psychology, and social relations. The weights of physical symptoms from high to low included pain, side effects of treatment, sleep, daily life, appetite, fatigue, and facial expression. The weights of mental psychology from high to low included their cognition of disease, attitude, and spirit to treatment. The weights of social relations included the care and understanding of family and the understanding and cooperation of colleagues.

Conclusion

The weights of each quality of life scale indicator are obtained by hierarchical analysis. Then the different quality-of-life survival time is converted into quality-adjusted life years, which can provide a basis for the influence of palliative care services on the quality-adjusted life years of patients with advanced cancer.

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目的

研究癌症晚期患者质量调整生命年的测量方法，为该人群姑息关怀服务评价提供依据。

方法

通过专家咨询法对量表中各项指标的重要性进行比较，并采用层次分析法得到各指标的权重。

结果

量表中一级指标权重由高到低分别是躯体症状、精神心理、社会关系；躯体症状的二级指标权重由高到低排序分别是疼痛、治疗的副作用、睡眠、日常生活、食欲、疲乏、面部表情；精神心理的二级指标权重由高到低排序分别是自身对疾病的认知、对治疗的态度、精神；社会关系的二级指标权重由高到低排序分别是家庭的照顾与理解、同事的理解与配合。

结论

通过层次分析法得到生命质量量表各指标的权重，可将不同生命质量下的生存时间换算为质量调整生命年，为后续研究姑息关怀服务对癌症晚期患者质量调整生命年的影响的评价提供了工具。

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吴皓，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=tXqoLmNzM4zlg5RfxGkX/A==, magXml=COnPaamBPaR7e1dF3y1gvg==, pdfUrl=null, pdf=+DMuTaxts/C2bSeksr/iyQ==, pdfFileSize=586652, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=yca/W+2K5oLfF2ugPaDGlg==, mapNumber=null, authorCompany=null, fund=null, authors=

林萍（1984—），女，博士，副研究员，研究方向：医院管理，卫生经济学、卫生政策管理、公共卫生教育

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林萍（1984—），女，博士，副研究员，研究方向：医院管理，卫生经济学、卫生政策管理、公共卫生教育

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林萍（1984—），女，博士，副研究员，研究方向：医院管理，卫生经济学、卫生政策管理、公共卫生教育

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Shanxi Medical Journal, 2023, 52(13): 988-992., articleTitle=Study on the application of palliative prognosis index in community palliative care for patient survival analysis, refAbstract=null), Reference(id=1240746314179334620, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375119986610767, doi=null, pmid=null, pmcid=null, year=2023, volume=47, issue=11, pageStart=1406, pageEnd=1408, url=null, language=null, rfNumber=[10], rfOrder=15, authorNames=陶誉鹭, 冯校, 何淑玲, journalName=黑龙江医学, refType=null, unstructuredReference=陶誉鹭，冯校，何淑玲．肺癌患者姑息照护的研究进展[J]．黑龙江医学，2023，47（11）：1406-1408．, articleTitle=肺癌患者姑息照护的研究进展, refAbstract=null), Reference(id=1240746314259026399, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375119986610767, doi=null, pmid=null, pmcid=null, year=2023, volume=47, issue=11, pageStart=1406, pageEnd=1408, url=null, language=null, rfNumber=[10], rfOrder=16, authorNames=Tao YL, Feng J, He SL, journalName=Heilongjiang Medical Journal, refType=null, unstructuredReference=Tao YL,Feng J, He SL. 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Hierarchy table of quality of life scale indicators for cancer patients

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一级指标二级指标
1.躯体症状1.1食欲
1.2睡眠
1.3疲乏
1.4疼痛
1.5日常生活
1.6治疗的副作用
1.7面部表情
2.精神心理2.1精神
2.2自身对疾病的认识
2.3对治疗的态度
3.社会关系3.1家庭的照顾与理解
3.2同事的理解与配合
), ArticleFig(id=1240746311213961560, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375119986610767, language=CN, label=表1, caption=

癌症患者生命质量量表指标层次表

, figureFileSmall=null, figureFileBig=null, tableContent=
一级指标二级指标
1.躯体症状1.1食欲
1.2睡眠
1.3疲乏
1.4疼痛
1.5日常生活
1.6治疗的副作用
1.7面部表情
2.精神心理2.1精神
2.2自身对疾病的认识
2.3对治疗的态度
3.社会关系3.1家庭的照顾与理解
3.2同事的理解与配合
), ArticleFig(id=1240746311394316639, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375119986610767, language=EN, label=Table 2, caption=

Quantitative table of familiarity with indicators

, figureFileSmall=null, figureFileBig=null, tableContent=
熟悉程度量化值
很熟悉1.0
比较熟悉0.8
一般0.6
不熟悉0.4
很不熟悉0.2
), ArticleFig(id=1240746311503368545, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375119986610767, language=CN, label=表2, caption=

指标熟悉程度量化表[7]

, figureFileSmall=null, figureFileBig=null, tableContent=
熟悉程度量化值
很熟悉1.0
比较熟悉0.8
一般0.6
不熟悉0.4
很不熟悉0.2
), ArticleFig(id=1240746311599837542, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375119986610767, language=EN, label=Table 3, caption=

Quantitative table of indicator judgment basis

, figureFileSmall=null, figureFileBig=null, tableContent=
判断依据影响程度
大中小
理论分析0.30.20.1
实践经验0.50.40.3
文献查阅0.10.10.1
直觉判断0.10.10.1
), ArticleFig(id=1240746311708889455, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375119986610767, language=CN, label=表3, caption=

指标判断依据量化表[7]

, figureFileSmall=null, figureFileBig=null, tableContent=
判断依据影响程度
大中小
理论分析0.30.20.1
实践经验0.50.40.3
文献查阅0.10.10.1
直觉判断0.10.10.1
), ArticleFig(id=1240746311805358451, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375119986610767, language=EN, label=Table 4, caption=

Basic information of experts

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特征分组人数（人）构成比（%）
性别男1133.3
女2266.7
年龄（岁）<401957.6
40~591339.4
≥6013.0
学历博士1442.4
硕士927.3
本科1030.3
职称正高级515.2
副高级927.3
中级1957.6
工作单位医院2678.8
高校721.2
工作年限（年）5~91133.3
10~191236.4
20~29721.2
≥3039.1
), ArticleFig(id=1240746311893438840, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375119986610767, language=CN, label=表4, caption=

专家基本情况

, figureFileSmall=null, figureFileBig=null, tableContent=
特征分组人数（人）构成比（%）
性别男1133.3
女2266.7
年龄（岁）<401957.6
40~591339.4
≥6013.0
学历博士1442.4
硕士927.3
本科1030.3
职称正高级515.2
副高级927.3
中级1957.6
工作单位医院2678.8
高校721.2
工作年限（年）5~91133.3
10~191236.4
20~29721.2
≥3039.1
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Self evaluation results of expert authority level

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一级指标熟悉程度判断依据权威系数
躯体症状0.9210.9390.930
精神心理0.8120.8940.853
社会关系0.7940.8270.811
平均值0.8420.8870.865
), ArticleFig(id=1240746312082182526, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375119986610767, language=CN, label=表5, caption=

专家权威程度自评结果

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一级指标熟悉程度判断依据权威系数
躯体症状0.9210.9390.930
精神心理0.8120.8940.853
社会关系0.7940.8270.811
平均值0.8420.8870.865
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Coordination coefficient and chi square test of evaluation indicators

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指标协调系数Wχ2P
一级指标0.77651.1880.000
二级指标0.664240.9510.000
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评价指标的协调系数与卡方检验

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指标协调系数Wχ2P
一级指标0.77651.1880.000
二级指标0.664240.9510.000
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Weights of scale indicators

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一级指标权重二级指标权重组合权重
躯体症状0.593 4食欲0.080 70.047 9
睡眠0.145 40.086 3
疲乏0.058 10.034 5
疼痛0.390 60.231 8
日常生活0.105 00.062 3
治疗的副作用0.184 50.109 5
面部表情0.035 70.021 2
精神心理0.315 7精神0.300 90.095 0
自身对疾病的认识0.369 00.116 5
对治疗的态度0.330 10.104 2
社会关系0.090 8家庭的照顾与理解0.830 60.075 5
同事的理解与配合0.169 40.015 3
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量表指标权重表

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一级指标权重二级指标权重组合权重
躯体症状0.593 4食欲0.080 70.047 9
睡眠0.145 40.086 3
疲乏0.058 10.034 5
疼痛0.390 60.231 8
日常生活0.105 00.062 3
治疗的副作用0.184 50.109 5
面部表情0.035 70.021 2
精神心理0.315 7精神0.300 90.095 0
自身对疾病的认识0.369 00.116 5
对治疗的态度0.330 10.104 2
社会关系0.090 8家庭的照顾与理解0.830 60.075 5
同事的理解与配合0.169 40.015 3
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癌症晚期患者质量调整生命年的测量方法研究
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林萍 1 , 陈慧平 1 , 彭伟 1 , 贾艳皊 1 , 杨青 2 , 韩佳禹 4 , 吴皓 3
现代预防医学 | 流行病与统计方法 2024,51(6): 994-997
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现代预防医学 | 流行病与统计方法 2024, 51(6): 994-997
癌症晚期患者质量调整生命年的测量方法研究
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林萍1, 陈慧平1, 彭伟1, 贾艳皊1, 杨青2, 韩佳禹4, 吴皓3
作者信息
  • 1.四川大学华西公共卫生学院/四川大学华西第四医院，四川 成都 610041
  • 2.四川省肿瘤医院
  • 3.四川省妇幼保健院.成都医学院附属妇女儿童医院
  • 4.四川省成都市龙泉驿区妇幼保健院

    • 林萍（1984—），女，博士，副研究员，研究方向：医院管理，卫生经济学、卫生政策管理、公共卫生教育

通讯作者:

吴皓，E-mail：
Measurement methods of quality-adjusted life years for advanced cancer patients
Ping LIN1, Hui-ping CHEN1, Wei PENG1, Yan-ling JIA1, Qing YANG2, Jia-yu HAN4, Hao WU3
Affiliations
  • West China University of Public Health, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2024-03-25 doi: 10.20043/j.cnki.MPM.202311424
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摘要
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目的

研究癌症晚期患者质量调整生命年的测量方法，为该人群姑息关怀服务评价提供依据。

方法

通过专家咨询法对量表中各项指标的重要性进行比较，并采用层次分析法得到各指标的权重。

结果

量表中一级指标权重由高到低分别是躯体症状、精神心理、社会关系；躯体症状的二级指标权重由高到低排序分别是疼痛、治疗的副作用、睡眠、日常生活、食欲、疲乏、面部表情；精神心理的二级指标权重由高到低排序分别是自身对疾病的认知、对治疗的态度、精神；社会关系的二级指标权重由高到低排序分别是家庭的照顾与理解、同事的理解与配合。

结论

通过层次分析法得到生命质量量表各指标的权重，可将不同生命质量下的生存时间换算为质量调整生命年，为后续研究姑息关怀服务对癌症晚期患者质量调整生命年的影响的评价提供了工具。

姑息关怀  /  癌症晚期  /  质量调整生命年  /  测量方法
Objective

Quality of life and survival time are important contents of palliative care services for patients with advanced cancer. Therefore, investigating the measurement method of quality-adjusted life years for patients with advanced cancer could provide a basis for the evaluation of palliative care services for this population.

Methods

The relative importance of each index in the Quality-of-Life Scale of Cancer Patients was compared by expert consultation method and hierarchical analysis was used to obtain the weight of each index.

Results

In the Quality-of-Life Scale of Cancer Patients, the weights of primary indicators from high to low included physical symptoms, mental psychology, and social relations. The weights of physical symptoms from high to low included pain, side effects of treatment, sleep, daily life, appetite, fatigue, and facial expression. The weights of mental psychology from high to low included their cognition of disease, attitude, and spirit to treatment. The weights of social relations included the care and understanding of family and the understanding and cooperation of colleagues.

Conclusion

The weights of each quality of life scale indicator are obtained by hierarchical analysis. Then the different quality-of-life survival time is converted into quality-adjusted life years, which can provide a basis for the influence of palliative care services on the quality-adjusted life years of patients with advanced cancer.

Palliative care  /  Advanced cancer  /  Quality-adjusted life years  /  Measurement method
林萍, 陈慧平, 彭伟, 贾艳皊, 杨青, 韩佳禹, 吴皓. 癌症晚期患者质量调整生命年的测量方法研究. 现代预防医学, 2024 , 51 (6) : 994 -997 . DOI: 10.20043/j.cnki.MPM.202311424
Ping LIN, Hui-ping CHEN, Wei PENG, Yan-ling JIA, Qing YANG, Jia-yu HAN, Hao WU. Measurement methods of quality-adjusted life years for advanced cancer patients[J]. Modern Preventive Medicine, 2024 , 51 (6) : 994 -997 . DOI: 10.20043/j.cnki.MPM.202311424
正文
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随着疾病谱的变化和“生物-心理-社会”医学模式的确立，生命质量作为疗效评估指标越来越被重视，尤其是对于癌症等慢性病而言，生命质量显得尤其重要。有研究表明：姑息关怀治疗相对于常规抗癌治疗，对癌症晚期患者生命质量的改善及疼痛的缓解均有更显著的效果[1-3]。然而，仅凭生命质量这一个效果指标还不能充分说明姑息关怀治疗的临床价值，一项治疗措施除了影响患者的健康状况，还会影响患者的生存期。健康是生存期和生命质量的函数，质量调整生命年理论正是因为具有将二者合二为一的特点而被提出，它是一种调整的期望寿命，用于评价和比较健康干预，通过给予每个生命年一个权重来进行估计（完全健康状态记为1，死亡记为0），将不同生命质量的生存时间换算成相当于完全健康人的生存年数（QALYs=生存期×生命质量权重），可以比较不同治疗方式对患者生存时间和生命质量的综合影响，从而科学的评价治疗的效果。在实际应用时，生命质量的权重可以通过患者或该领域的专家判断来确定[4]。目前国内外对QALYs测量方法的研究较少，尤其是针对晚期癌症患者这个特殊群体，因此本研究拟以癌症晚期患者为对象，通过专家咨询法对癌症晚期患者生命质量量表中各项指标的重要性进行比较，并采用层次分析法得到各指标的权重，以此为后续科学评价不同治疗方式对癌症晚期患者质量调整生命年的影响提供依据。
1 研究方法
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本研究拟通过专家咨询法对量表[5]（下文简称量表）中各项指标的重要性进行比较，并采用层次分析法得到各指标的权重。
1.1 专家咨询法
1.1.1 问卷设计
专家咨询问卷包括三个部分：
1.1.1.1 专家基本信息调查表
专家基本信息调查表包括年龄、学历、职称、工作年限、工作领域及学术专长等基本信息。
1.1.1.2 量表指标重要性评分表
将量表分为3个层次，分别为总目标层、一级指标层和二级指标层，一级指标层包括躯体症状、精神心理和社会关系3个一级指标，二级指标层包括12个二级指标，分别对应1个代表性问题。采用层次分析法软件Yaahp 12.1构造层次结构模型，并生成指标重要性评分表。详见表1。
1.1.1.3 专家权威程度自评表
专家权威程度自评表包括两部分，分别是一级指标熟悉程度表和判断依据及影响程度表。
1.1.2 专家遴选与调查
专家的选择是专家咨询法的关键环节，既要考虑专家的基本条件如学历、职称、工作年限、研究领域等，又要兼顾本研究的目的和内容，因此，我们确定了以下专家遴选条件：（1）三甲医院中从事姑息医学、姑息护理、肿瘤学、放射治疗等领域的专家，他们具有丰富的临床实践经验，了解癌症患者的生活状况，对指标的重要性有切身体会；（2）高等医学院校中从事社会医学及卫生事业管理、健康与社会行为学、流行病与卫生统计学、慢性病防控研究的专家，他们从事多年生命质量相关理论研究，具有坚实的理论基础；（3）专家的职称为中级及以上，工作年限为5年及以上；（4）热心支持本次研究工作，能积极配合课题组完成咨询问卷的专家。遴选专家后，以纸质版或电子邮件的形式将专家咨询问卷发放给专家。
1.1.3 可靠性分析
本研究采用专家积极程度、权威程度和协调程度3项指标对专家咨询的可靠性进行检验[6]。
（1）专家积极程度：即专家对本研究的关心、合作程度，专家积极程度由积极系数反映，以专家咨询表回收率表示，专家积极系数=（回收咨询表总数/发放咨询表总数）×100%。
（2）专家权威程度：专家权威程度由专家对指标的判断依据与熟悉程度决定，权威系数Cr为熟悉程度系数Cs和判断系数Ca的算术平均值，即Cr=(Cs+Ca)/2。权威系数Cr数值范围在0~1之间，值越大，表明专家权威性越高。专家权威程度以自我评价为主。
专家熟悉程度分为很熟悉、比较熟悉、一般、不熟悉、很不熟悉，具体赋值量化表见表2。
专家判断系数通过对理论分析、实践经验、文献查阅、直觉判断四方面进行量化，影响程度分为大、中、小，具体赋值量化表见表3。
（3）专家协调程度：专家协调程度用Kendall协调系数W表示，它是用来反映专家组中各专家彼此间对每项指标给出的评价意见是否存在较大分歧。W值的范围是0~1，W值越大，表示所有专家对全部评价指标评分的协调程度越高；反之，协调程度越差，说明专家意见存在较大的不一致性。协调系数计算公式如下：
式中：m为专家数，n为指标数，dj为第j个指标重要性评分与全部指标重要性评分之差。
1.2 层次分析法
本研究采用层次分析法确定各级指标的权重。采用Satty相对重要性等级表区分指标的相对重要性，通过专家咨询，让专家对同层次的指标两两比较，并进行相对重要性评分，以此构建判断矩阵，并进行一致性检验，从而得到各级指标的权重，最后利用概率乘法原理计算各指标的组合权重。
1.3 统计学方法
应用SPSS 24.0计算专家的积极系数、权威系数及协调系数，P<0.05为有统计学意义；采用层次分析法软件Yaahp 12.1构造层次结构模型及判断矩阵，并进行权重的计算和一致性检验。
2 结果分析
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2.1 专家基本情况
最终确定专家33人，2/3的专家具有10年以上的工作经验，拥有研究生及以上学历的专家超过2/3，详见表4。由此可见，入选专家能充分保证咨询结果的有效性和权威性。
2.2 专家咨询可靠性
专家咨询中，发放问卷33份，回收33份，问卷回收率为100%，专家积极系数为100%。说明本次专家咨询中专家的积极性较高。
专家权威程度自评结果详见表5。专家权威程度的高低对评价结果的可靠性有重大影响，一般认为专家权威系数≥0.7为可接受水平[7]。因此，本次咨询结果具有较高的权威性。
根据专家评分结果，对一级指标和二级指标分别进行Kendall协调系数W检验，一级指标的协调系数为0.776（χ2＝51.188，P<0.001）；二级指标的协调系数为0.664（χ2＝240.951，P<0.001），说明专家对评价指标的重要性认识基本趋于一致，意见协调性较好，得到的指标体系可信度较高，详见表6。
2.3 构造层次结构模型
采用层次分析法软件Yaahp 12.1构造层次结构模型及判断矩阵，所有判断矩阵的一致性检验系数CR均<0.1，表明具有满意的一致性。根据软件输出的结果构建量表指标权重表，得到：一级指标权重由高到低分别是躯体症状、精神心理、社会关系；躯体症状的二级指标权重由高到低排序分别是疼痛、治疗的副作用、睡眠、日常生活、食欲、疲乏、面部表情；精神心理的二级指标权重由高到低排序分别是自身对疾病的认知、对治疗的态度、精神；社会关系的二级指标权重由高到低排序分别是家庭的照顾与理解、同事的理解与配合。以上结果与前文的研究结果基本一致，该指标权重能较好的反映生命质量量表中各指标的重要性，详见表7。
3 讨论
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3.1 生命质量量表选择的科学性
近几十年来，生命质量广泛用于对癌症治疗效果等方面的评价。各国学者一直致力于量表的开发与研制，目前公开发表的医学领域的生命质量测定量表有百余种，且一些新的量表还在研发中。不同量表其使用的对象、范围和特点也各不相同。本文拟研究癌症晚期患者的生命质量，在量表选择上，首先，要对所有癌症患者都具有普适性；其次，由于该群体的特殊性，应选择简单易懂，方便作答的量表；最后，本文调查的是中国癌症患者，应选择具有中国文化特色的量表，减少因文化差异造成的测量偏差。基于以上几个方面，在综合比较国内外各种生命质量量表的基础上，选择我国肿瘤专家孙燕等人编著的中国癌症患者生命质量量表（Quality of Life Questionnaire，QLQ）[5]做为本文对癌症晚期患者生命质量的评估量表。该量表已通过信度、效度检验，证明其具有较好的可靠性和有效性，同时它也是李嘉诚基金会“人间有情”全国宁养医疗服务计划中32家宁养院使用的癌症患者生命质量量表，具有普遍的代表性。
3.2 生命质量权重评估的有效性和可靠性
从医学和社会学角度来看，一般应用效用指标QALYs来评估与生存时间和生存质量相关的干预措施的成本效果，考虑了个体、家庭、卫生服务提供者和群体对健康的偏好。在计算QALYs时，最为关键的是如何计算生命质量权重，而由谁来评估不同健康状态的生命质量权重目前有三个观点：第一种认为应由该卫生项目覆盖的目标人群来评估，因为他们具有健康经验。第二种认为应使用整个人群来评估，因为整个人群代表着潜在的病人。第三种认为应以研究者的评估为基础，专家判断法通常被用来确定生命质量权重，这更接近于估计QALYs的政策制定方法[4]。本文的研究对象为癌症晚期患者，其身体状况和心理状态都不太适合做出客观的判断，而本研究也不具备大规模的人群调查基础，因此采用专家咨询法对生命质量的权重进行评估可行且可靠。
3.3 癌症晚期患者质量调整生命年的测量对姑息关怀服务的发展意义重大
对于癌症晚期患者来说，有限生存时间内的生命质量固然重要，但若是以缩短生存期为代价，势必会引起争议。治疗的效用如何评估，应综合考虑对患者生命质量和生存时间的影响。笔者在后续研究中发现，经姑息关怀治疗的癌症晚期患者的生命质量效用值显著高于经常规抗癌治疗的患者。这与国内外大多数学者的研究结果一致：姑息关怀治疗在提高患者生命质量的同时，也显著延长患者的生存期[8-11]。因此应大力加强对姑息关怀服务的宣传和推广、加大资源投入、加强姑息关怀治疗的医疗安全和医疗质量管理，促进姑息关怀服务在国内的普及和发展，这对我国医疗事业发展具有非常重要的意义。
本研究通过专家咨询法对量表中各项指标的重要性进行评估，运用层次分析法得到中国癌症患者生命质量量表各指标权重，从而为测算我国癌症晚期患者质量调整生命年提供参考。受研究条件的限制，本研究存在评估对象结构单一、专家咨询样本量不大、生命质量量表选择面窄等局限性，期待有更多的学者专家关注癌症晚期患者的生命质量，在该领域做出更多科学的、有价值的研究。
基金
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  • 成都市哲学社会科学重点研究基地四川大学健康城市发展研究中心立项项目(2023ZZ001)
文献
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2024年第51卷第6期
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doi: 10.20043/j.cnki.MPM.202311424
  • 接收时间：2023-11-22
  • 首发时间：2026-03-16
  • 出版时间：2024-03-25
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  • 收稿日期：2023-11-22
基金
成都市哲学社会科学重点研究基地四川大学健康城市发展研究中心立项项目(2023ZZ001)
作者信息
    1.四川大学华西公共卫生学院/四川大学华西第四医院，四川 成都 610041
    2.四川省肿瘤医院
    3.四川省妇幼保健院.成都医学院附属妇女儿童医院
    4.四川省成都市龙泉驿区妇幼保健院

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2种不同金属材料的力学参数
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小菇属 Mycena 11 5.26
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红菇属 Russula 17 8.13
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