摘要
善終是末期照顧成果重要指標之一，但善終概念屬性的複雜與多元，加上其動態的本質，致使善終評量面臨瓶頸與挑戰。本文搜尋文獻發現有九個較為常見的「善終」或「臨終與死亡品質」測量工具；進而檢視各評量工具的評量內容、被評量者、題數、計分方式、工具信效度及評量者。評析結果發現評量工具內容涵蓋3～18個層面，評量者大多數為家屬或醫療專業人員，工具信效度則以內容一致性及專家內容效度的檢測最常見。有些評量工具內容參雜著其他構念成份而超出「臨終品質」的評量範圍，評量結果方面，可能會因為不同的評量者、評量時機以及未以病人的偏好為依據而導致差異。據此評析結果，建議未來可將善終偏好納入預立醫療照護計畫的討論內容，以提早評量病人對善終的想法與期待，提供更符合末期病人需求之優質末期照顧，並作為日後病人臨終時，評量其是否達到善終的依據以及生命末期照顧品質的重要評價指標之一。
並列摘要
One of the most important outcomes of end-of-life care is achieving a ”good death” or a ”good dying process.” Since the complexity and diversity attributes and the dynamic nature of good death, it made this outcome measurement so difficult and challenged. The purposes of this article were to discuss the measures of good death that were currently used in the literature. Nine published measures were found. The aspects of discussion include contents, items, scoring, validity, reliability and rater. The domains of the instruments varied from three to eighteen. The item number ranged from five to thirty one. Most measurements relied upon retrospective reports by family caregivers and/or clinicians. The reliability of the instruments mostly been tested by Cronbach's αcoefficients and the validity mostly been examined by experts. Some instruments constituted scopes beyond the ”good death” or ”quality of dying and death” construct. The varied results of measures may come from different raters, administration timing and the assessment not base on patients' preferences. We suggest to incorporate the preferences and desires of patients toward good death into advance directive care plan and to discuss it with patients as early as possible in the future. Thus, it enables the clinicians to provide the tailored end-of-life care that can meet patients' needs, and to serve as the base for measuring the achievement of good death. The appropriate good death measurement could demonstrate the effectiveness of the effort in end-of-life care.
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延伸閱讀
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