关键词: 临终医护, 安宁疗护, 社区卫生服务中心, 恶性肿瘤, 采访（主题）, 满意度

Abstract: Background　Hospice care has been implemented in Shanghai for over 30 years，and currently it can be accessed from all the community health centers（CHCs） （n=246） in the city.Actions taken in these years by Shanghai such as pilot projects promotion，development of standards for hospice care and hospice care-related trainings for medical workers，have promoted the sustainable，standardized and efficient development of hospice care.Objective　To investigate hospice care resource use related to cancer management and hospice care physicians and nurses' occupational satisfaction based on a survey in community healthcare settings in Shanghai's central districts Methods　This survey was conducted from March to September 2019.From seven central districts（Huangpu District，Xuhui District，Yangpu District，Putuo District，Jing'an District，Changning District and Hongkou District） selected by simple random sampling，14 CHCs delivering hospice care as the pilot institutions were extracted by stratified sampling，from which 42 hospice care physicians and nurses were sampled by use of simple random sampling.Data about hospice care resource use，such as occupancy rate of hospice beds，average length of hospice care per capita，average medical expense per capita and average daily medical expense per capita in the hospice care center were collected from the 2018 health statistics and financial statements of these CHCs.A self-developed questionnaire named Hospice Care Physicians and Nurses' Occupational Satisfaction in Shanghai's Pilot Institutions for Hospice Care，involving general demographics，occupational satisfaction（evaluated in terms of salary and welfare，career development，professional identity，turnover intention，peer relationships，job satisfaction） and associated factors，was used to survey the participants.Results　In 2018，the occupancy rate of hospice beds，average length of hospice care per capita，average medical expense per capita and average daily medical expense per capita in the hospice care center were （48.42±2.34）%，（41.8±3.5） days，（7 632.8±234.7） yuan，（182.6±22.6） yuan，respectively.The average length of home hospice care per capita，average home medical expense per capita and average home daily medical expense per capita were （56.2±7.5） days，（1 371.3±186.4） yuan，and （24.4±4.2） yuan，respectively.Physicians and nurses showed low satisfaction with salary and welfare and career development，but high satisfaction with peer relationships and professional identity in delivering institution-based hospice care.They showed similar satisfaction with delivering home hospice care.The main factors associated with the delivery of institution-based hospice care by physicians and nurses were：the contradiction between heavy workload and low salary，the delivery of hospice care relying on the institution's own operating subsidies without enough special funds，high level of negative emotions and great mental burdens caused by long-term caring dying patients.The major factors associated with the delivery of home hospice care by physicians and nurses were：too much trivial details in care but low payment，insufficient number of hospice care practitioners，and insufficient attentions to home hospice care from all walks of life.Conclusion　The institution-based and home hospice care services delivered by CHCs in central districts of Shanghai may effectively reduce the social and family burden，but there are aspects need to be improved：low occupancy rate of hospice beds，low payment and occupational satisfaction of hospice care physicians and nurses，and unsatisfied referrals for cancer patients with hospice care between medical institutions.

Key words: Terminal care, Hospice care, Community health services center, Malignant tumors, Interviews as topic, Satisfaction