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

摘要： 背景　上海安宁疗护服务已走过30余年的历程，目前上海全市246家社区卫生服务中心已全部开展安宁疗护服务，经过多年的发展，上海积极推进试点、制订服务规范、实施能力培训等措施，有力推动了安宁疗护持续、规范、高效发展。目的　了解上海市中心城区社区医疗机构肿瘤安宁疗护资源使用状况及从业医护人员的满意度情况。方法　2019年3—9月采用单纯随机抽样法分别从上海市7个中心城区（黄浦区、徐汇区、杨浦区、普陀区、静安区、长宁区、虹口区）的14家试点安宁疗护社区卫生服务中心选取安宁疗护从业医护人员42名为研究对象。分析试点机构2018年卫生统计报表和财务报表（安宁疗护病床使用率、安宁疗护时间、安宁疗护中心人均医疗费用、安宁疗护中心日均医疗费用）。并采用自行设计的《上海市安宁疗护试点机构医护人员从业满意度调查问卷》对医护人员从业满意度进行调查与访谈，具体内容包括受访者的基本信息、从业满意度（薪资福利、职业发展、职业认同感、离职意向、同行关系、工作满意度）以及影响安宁疗护从业医护人员职业满意度的因素。结果　2018年上海市中心城区试点安宁疗护机构的安宁疗护病床使用率为（48.42±2.34）%；平均住院时间为（41.8±3.5）d，人均医疗费用为（7 632.8±234.7）元，日均医疗费用为（182.6±22.6）元；居家安宁疗护平均时间为（56.2±7.5）d，人均医疗费用为（1 371.3±186.4）元，日均医疗费用为（24.4±4.2）元。社区医疗机构安宁疗护从业医护人员对薪资福利、职业发展的满意度偏低，对同行关系和职业认同感的满意度偏高。安宁疗护从业医护人员对居家安宁疗护和机构安宁疗护的工作满意度结果相似。影响安宁疗护从业医护人员开展机构安宁疗护服务的主要因素是：“待遇较低、工作量大，付出与收获不成比例”“依靠机构自身运营补贴，专项经费不足”“长期面对即将死亡的患者，负面情绪和心理压力较大”；影响安宁疗护从业医护人员开展居家安宁疗护服务的主要因素是：“工作琐碎，医护人员待遇不足”“从业医护人员数量不足”“各方重视程度不足”。结论　上海市中心城区社区卫生服务中心和居家安宁疗护服务有效减轻了社会和家庭负担，但仍存在安宁病床的使用率不高，安宁疗护从业医护人员的待遇和满意度偏低，不同医疗机构间转诊不通畅等问题。

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