中国医学科学院学报2026，Vol.48Issue(1)：65-72,8.DOI:10.3881/j.issn.1000-503X.16923
缓和医疗医者能动性实践与策略:一项叙事与观察的融合研究
Practice and Strategies of Palliative Care Physicians'Agency:An Integrated Narrative and Observational Study
摘要
Abstract
Objective To explore how physicians exercise agency in palliative care under cultural,technological,and institutional constraints.Methods This study integrated death narratives with participatory observation in a palliative care center of a tertiary hospital in Beijing and systematically analyzed the data by re-flexive thematic analysis.Results Physicians faced three structural constraints:medical familism at the cultural level,which hindered information sharing and patient autonomy;a technology-first tendency leading to overtreat-ment and misaligned goals;and institutional resource shortages with marginalized values.In response,they em-ployed three key agency strategies:acting as communication mediators to build trust;serving as decision naviga-tors to refocus families on patient interests;and coordinating care networks to address psychosocial and spiritual needs.Conclusions Physicians demonstrate contextual and strategic agency in palliative care,creating space to improve care under structural constraints.This study provides empirical support for localized practice and high-lights the need for institutional reinforcement of physician agency.关键词
缓和医疗/叙事分析/医者能动性/安宁疗护/质性研究Key words
palliative care/narrative analysis/physician agency/hospice care/qualitative research分类
医药卫生引用本文复制引用
法翠雯,李旭,杜铁宽,丁希,宁晓红,周家欣,杨斐,宋敏,雍挺俊..缓和医疗医者能动性实践与策略:一项叙事与观察的融合研究[J].中国医学科学院学报,2026,48(1):65-72,8.基金项目
国家社会科学基金教育学西部项目(CBX230349)、国家社会科学基金青年项目(CSH081)和国家社会科学基金(19CSH055) （CBX230349）
