台灣居家安寧療護面臨困境之探討

The Obstacles of Home Hospice Care in Taiwan

黃郁珊(Yu-Shan Huang) ； 黃淑鶴(Shu-He Huang)

《安寧療護雜誌》 22卷2期 (2017/07) Pp. 180-191

https://doi.org/10.6537/TJHPC.2017.22(2).4

摘要

本文探討之居家安寧療護，為台灣面對快速高齡化社會，健康照護體系必須面對的議題。隨著台灣老年人口上升，加上癌症為台灣主要死因，安寧療護的理念也隨之萌芽發展。提供安寧療護地點也從醫院延伸到居家社區，對於疾病末期治療朝向提供身、心、靈舒適之安寧照護發展，然而居家安寧療護在台灣的利用率偏低，加上統計顯示多數末期病人期望能在家往生，但卻無法達成在家善終的期望。本文即針對病人家屬、醫護人員及政策面分別探討居家安寧療護利用上其可能障礙因素，發現病人及家屬對於安寧療護在照護經驗不足、擔心資源不足、錯誤認知及態度影響之下，而拒絕居家安寧；醫護人員在提供病人接受安寧照護時，常面臨缺乏臨床教育訓練、心理障礙、對瀕死病人照護知識不足等問題；另外，政府相關醫療照護政策制度及經費補助項目與限制，亦會影響安寧療護推動。在文末針對臨床人員教育、政策及未來科技結合層面給予建議，提供未來推動居家安寧療護之參考，期望提昇末期病人及家屬接受安寧居家照護的可近性，幫助末期病人可以返家持續得到照護達成壽終正寢願望。

關鍵字

居家安寧療護 ； 生命末期 ； 在宅死亡

並列摘要

The concept of hospice care has developed alongside the recently increasing elderly population and the status of cancer as a leading cause of death in Taiwan. Subsequently, hospice care services have been extended from hospitals to homes and have begun to focus on providing medical services that cater to the physical, mental, and spiritual needs of patients in terminal stages. However, the usage rate of home hospice care has remained low in Taiwan; statistics have even indicated that most patients in terminal stages did not pass away at home although they had the intention to do so. Thus, this study examined the potential factors impeding the implementation of home hospice care from the perspectives of patients' families, healthcare personnel, and medical policies. The results suggest that, under the influence of concerns about insufficient hospice care resources and misconceptions and negative perceptions about and toward hospice care, patients and family members generally refuse the adoption of home hospice care. When providing hospice care services to patients, healthcare personnel tend to face the problems of insufficient clinical medical training, related psychological obstacle, and a lack of knowledge pertaining to serving near-death patients. Moreover, government policies, regulations, and budgets for relevant hospice care services can affect the promotion of hospice care services. In the end of the article, suggesting that in the future, the relevant strategies have to be set from clinical practice, education, technology integration, and policies to improve the accessibility of end-of-life care for terminal stage patients and their families, helping patients in terminal stages can pass away at home.

並列關鍵字

home hospice ； end-of-life ； go home to die

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