目的 构建科学客观的肿瘤营养临床管理敏感指标体系,为肿瘤营养临床管理质量评价与监测提供参考依据。 方 法 以“结构-过程-结果”三维质量结构模型作为理论框架,制订检索策略。 根据纳入和排除标准独立进行文献筛选和资料提 取,使用相应的文献评价工具进行文献质量评估及证据级别评定,形成肿瘤营养临床管理敏感指标体系初稿。 采用德尔菲法 对北京市、上海市、广州市、重庆市、四川省 9 所三级甲等医院的 14 名专家进行两轮专家函询,运用专家积极系数、权威系数、 变异系数、协调系数等指标对专家咨询的可靠性和代表性进行检验,运用层次分析法确定各级指标权重。 结果 共开展两轮函 询,问卷有效回收率分别为 100%、92. 8%。 两轮函询专家的权威系数分别为 0. 946、0. 979,变异系数分别为 0. 135、0. 084,肯德 尔和谐系数分别为 0. 241(P<0. 01)、0. 284(P<0. 01)。 最终构建的敏感指标体系包括结构面 7 个指标,过程面 20 个指标,结 果面 4 个指标。 结论 构建的肿瘤营养临床管理敏感指标体系具有较高的科学性和可靠性,有利于提高肿瘤营养临床管理 质量。

Objective To construct a scientific and objective clinical management sensitive indicators for cancer nutrition in order to provide references for evaluating and monitoring the quality of care in cancer nutrition therapy. Method The structure-processoutcome model was used as the theoretical framework. Constructing a search strategy and searching for evidence. Literature screening and data extraction were conducted according to the inclusion and exclusion criteria by two researchers independently. Level of evidence and methodological quality were evaluated using relevant tools. The preliminary draft of clinical management sensitive indicators for cancer nutrition was formed based on evidence. 14 experts from 9 grade A tertiary hospitals in Beijing Shanghai Guangzhou Chongqing and Sichuan in China was consulted by Delphi method. To test the reliability and representativeness of expert consultation indicators such as expert positive coefficient authority coefficient variation coefficient and coordination coefficient were used. The analytic hierarchy process was used to determine the weight of indicators at all levels. Result The effective recovery rates of the 2 rounds of expert consultations were 100% and 92. 8% respectively. In the two rounds the expert authority coefficients were 0. 946 and 0. 979 the coefficients of variation were 0. 135 and 0. 084 and the Kendall harmony coefficients were 0. 241 P<0. 01 and 0. 284 P<0. 01 respectively. The final sensitive indicators included 7 structural indicators 20 process indicators and 4 outcome indicators. Conclusion The clinical management sensitive indicators for cancer nutrition is scientific and reliable which was helpful to improving the clinical quality in cancer nutrition.