社區慢性病老人對無效醫療看法之探討

鑑於無效醫療的研究多著重在醫療人員或倫理法律學家的見解，缺少民眾立場的觀點，本質性研究旨在探討居住於社區，75歲以上，且患有慢性病老人對無效醫療之看法。研究者以立意取樣收案，個別訪談9位居住於台南地區老人，將半結構式訪談過程，全程錄音，並轉錄為逐字稿。訪談資料以內容分析法進行分析，最後歸納五個主要主題與十三個次主題所構成。主題與次主題分別為：（1）感受無效處置存在－寄望醫療科技、依賴健保之福利、延長生命的痛苦、討論死亡議題；（2）重度慢性病造成家庭負荷－久病拖累家庭成員、加重經濟負擔、影響自身與家人情緒；（3）聽從醫師建議－尊重專業；（4）與慢性病共存－學習與疾病共處、重視銀髮健康、找尋社會支持；（5）醫療指示需及時－接受安寧意願高、對預立醫療指示存有不確定感。本研究結果可促使醫療相關單位及政府重視民眾對無效醫療的看法，進而帶動社區高齡長者對安寧療護和病人自主權利相關知識之提升。

關鍵字

社區老人；慢性病；無效醫療

並列摘要

Most studies of futile care focus on the perspective of ethicists, lawyers, and health care providers. This qualitative study explores perceptions of medical futility in community-dwelling older adults 75 years or older with chronic illnesses. Nine older adults were recruited through purposive sampling to participate in individual face-to-face interviews. These semi-structured interviews were audio-taped, transcribed verbatim and analyzed by content analysis. Five themes and thirteen sub-themes emerged from the data: (1) Sense of medical futility: expectations of medical technology, dependence on the National Health Service, prolonging the agony of life, discussion of death-related issues; (2) Severe chronic disease as a caregiver’s burden: encumbering family members, financial burden, physical and psychological burden; (3) Compliance with the physician's advice: respect toward professionals; (4) Living with chronic disease: learning to live with the disease, watching for health problems, looking for social support; and (5) Documenting advance directives in a timely manner: favoring palliative care, uncertainty regarding advance directives. Study findings may help health-related institutions understand medical futility from the perspective of health care consumers, which will allow them to better inform community-dwelling old adults about palliative care and the Patient Autonomy Bill.

並列關鍵字

community-dwelling older adults ； chronic illnesses ； medical futility

參考文獻

Dwelling People--A Practical Approach with Cultural Differences in Eastern Taiwan, Taiwan Journal of Hospice Palliative Care,18(1), 1-13.]

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謝至鎠、王淑貞、王英偉（2013）．符合社區民眾預立醫療自主計劃文化觀點之介入模式台灣花蓮地區之經驗‧安寧療護雜誌，18 (1)，1-13。[Hsieh, J. G., Wang, S. C.,＆Wang, Y. W. ( 2013). Promoting Advance Care Planning for Community-

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社區慢性病老人對無效醫療看法之探討

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