以主路徑分析法探討中高齡者之多維度生命末期照護概念

The Discussion of Middle-aged and Older Adults' Multidimensional End-of-life Care: Main Path Analysis

施勝烽(S.-F. Shih) ； 盧煜焬(Y.-Y. Lu)

《福祉科技與服務管理學刊》 3卷4期 (2015/09) Pp. 385-400

https://doi.org/10.6283/JOCSG.2015.3.4.385

摘要

隨著治療時間的不一致，未來治癒性醫療與支持性醫療應是相輔相成的，彼此間具有關聯性，這一個關聯性最終是以中高齡者病人與家屬「生活品質」的優劣作為評估指標。本文透過當代各國實證資料的蒐集和分析，進一步回顧中高齡者生命末期照護（end-of-life care, EOLC）相關研究結果之演進脈絡。從社會網絡概念著手，以引用分析為演算法基礎的主路徑分析法（main path analysis）找出全球過去二十年來EOLC相關文獻開枝散葉的發展脈絡。整理出四點分類範疇：（1）高標準的生命末期照護；（2）優質的健康照護；（3）高水平的知識與能力；（4）優質的溝通。此外讓臨床工作者在面對中高齡者實務照護工作時，除專業照護智能外，也能兼顧EOLC過程的多重面向技能。過去全球重視EOLC提供以病人為中心的連續性照護，依據其需求不同的疾病狀況、身體功能、心理社會功能與靈性功能所引起的困擾，藉由臨床工作者連結中高齡者家庭（家屬）照護資源，使其獲得適切的照護服務，進一步界定出臨床工作者的目標與內外部的協調機制（助力、整合、定位與主導力），並協助中高齡者病人與家屬適應疾病、改善生活品質以及心理復原的重建。

關鍵字

主路徑分析法 ； 中高齡者 ； 生命末期照護 ； IPSO協調機制

並列摘要

Because a different treatment period is required, future curative care and supportive care in EOLC will be essentially complementary to each other. The performance of EOLC can be assessed according to quality of life among patients and their families. This study mainly discusses middle-aged and older adults at the implementation stage of end-of-life care (EOLC). First, we collect and analyze domestic clinical evidence; meanwhile, we organize references for tracing the development trajectory of EOLC in other countries, to compare to that at home. We use main path analysis, based on the algorithm concept of social networks, to trace the divergence and convergence of EOLC development abroad over the past twenty years. From interviews with focus groups and collection of clinically operational data, this study summarizes four EOLC domains: (1) high-standard EOLC; (2) high-quality health care; (3) high-level knowledge and competence; and (4) high-quality communication. Additionally, clinical workers learn multiple aspects of EOLC to satisfy patients' and families' real needs. Therefore, EOLC emphasizes patient-centered continuity of care to give patients with various illnesses more comfort care, by involving clinician and family nursing resources to address physical, psychosocial and spiritual suffering. Furthermore, we identify goals of EOLC and establish an internal and external coordination mechanism for clinical workers, called IPSO, which can help patients and families improve the quality of life and reach psychological rehabilitation.

並列關鍵字

main path analysis ； middle-aged and older adults ； end-of-life care (EOLC) ； IPSO coordination mechanism