高齡末期病人家屬選擇病人臨終場所的決策過程

2018年台灣已正式邁入高齡社會，隨著老化人口的增加，高齡末期照護需求的增加，本研究旨在探討高齡末期病人家屬選擇病人臨終場所的決策過程，研究對象為高齡末期病人且接受過安寧照護之家屬為對象，以立意取樣方式自南部某醫學中心選擇收案對象，本研究依據現象學研究法，經由觀察及深度訪談進行資料收集，完成11位研究對象，進行分析。研究結果呈現高齡末期病人家屬選擇病人臨終場所的決策過程共有分別為決策前期、決策中期及決策後期三個範疇，涉及13個主題面向及挑戰。「決策前期~內在的自我束縛｣包含「身心的磨難｣、「傳統社會期待與孝道壓力｣、「過去經驗｣等三個主題;「決策中期~現實中的拉扯與轉化｣包含「病人自主意願的表達｣、「人工營養與流體餵養的迷失｣、「醫療資源的運用｣、「社會資源網路｣、「家庭因應事件的處理能力｣、「居家環境的侷限｣等六個主題;「決策後期~生死無盡｣包含「從擺盪中取得平衡｣、「覺知離別即將到來｣、「順服上天安排｣、「道別∼重新賦予意義｣等四個主題。研究結果顯示若病人自主意願得以表達，有信任的專業醫療團隊陪伴，強化社會支持網絡及家庭成員因應能力，則能幫助病人及家屬順利隨病程轉化進入以在宅善終為目標的臨終準備。此研究結果可供給末期照護領域之專業人員，對高齡末期病人家屬臨終場所決策經驗有更深入的認識，提供符合末期病人及家屬個別性的照護服務。未來建議積極發展社區醫療照護網絡、運用多元化的策略提供末期照護、推動預立醫療照護諮商，協助末期病人尊嚴而平安的過世，家屬亦能順利度過照顧臨終病人與喪親的心路歷程。

關鍵字

高齡者；末期病人；臨終場所；決策過程

並列摘要

Taiwan has officially become an aged society in 2018. With increase aging population, the demand for elderly care at the end of life also increases. The purpose of this study was to explore the decision- making process of choosing the place of death for elderly terminal patient among their family members. The research subjects were the family members of elderly terminal patient who had received Hospice Palliative Care. The samples were sampled by purposive sampling method from a medical center in southern Taiwan. Based on the phenomenological research method, this study collected data through observation and in-depth interviews from 11 samples.The results of the study showed that the family member's decision-making process of choosing the place of death for elderly terminal patient could divided into three periods: early period, middle period and late period, with 13 themes and challenge. " Early period：Intrinsic self-restraint" includes three themes："Physical and mental suffering", "Stress from traditional social expectations and filial piety", and "Past experience"," Middle period：Conflicts and transformation in practical situation " includes six themes：" Willingness expressed by the patient automatical", " The opinions of artificial nutrition and hydration", "The use of medical resources", "Social resource network", " Ability of coping with family incidents ", "Limitations of the home environment" ;"Late period：Living towards death " includes four themes: " From ups and downs to calm ", "Awareness of Separation due to death", " Accept the arrangement of God ", "Farewell：giving new meaning". The results of this study could provide to professionals in the terminal care field for a deeper understanding of the decision-making experience of the family members of elderly terminal patient , and provide individualized care services that suitable for the terminal patient and their families. In the future, it is recommended to actively develop a community medical care network, use a diversified strategy to provide terminal care, promote Advance Care Planning, and assist the terminal patient died with dignity and peace, in order to help family members could successfully pass through the mentality of caring for dying patients and bereavement.