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OA

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.