- 期刊
它山之石，可以攻玉：從國外團體預立醫療照護諮商經驗看臺灣預立醫療照護諮商之發展
Group Visits for Advance Care Planning in Taiwan Based on Foreign Experience
摘要
病人自主權利法在2015年12月18日通過立法，預立醫療照護諮商（以下簡稱ACP）在臺灣執行近一年，但參與人數不多。ACP在美國、英國及澳洲等國家已發展多年，各國在發展過程中都肯定ACP可以增加病人的滿意度也可以減少醫療成本的支出。但各國執行多年，即使在美國保險已開始給付諮商照護費用，但成效不彰，主要是因為ACP過程耗時、醫療團隊沒有時間或缺乏專業諮商技巧。因此美國、加拿大等國家開始發展團體ACP方法，運用在老年人及越戰退休榮民等，也提高了ACP完成率。臺灣目前以自費門診方式進行，醫療院所可能因為人力及時間成本考量，因此影響了推動的意願也影響了民眾善終的權益。北市聯合醫院也發展團體方式推動ACP，運用團體方式的運作，在團體發展過程中產生的團體動力讓意願人進行個人生命及價值信念探索，且讓ACP的執行更有效益。
並列摘要
Patient Right to Autonomy Act was legislated on December 18th, 2015. Advance care planning has been implemented in Taiwan for almost one year, while the participation rate is low. Advance care planning has been developed in several countries for many years, such as: United States, United Kingdom, and Australia. In the process of developing Advance care planning, all of the countries have definitely proved that it not only increases the satisfaction of patients but also reduces the medical costs. During all countries executing the policy for many years, even if the fee has been paid by Medicare or Medicaid, the implementation results are ineffective. The main reason is because the ACP process is time-consuming. Also, the skills of medical professional members are not well-trained. Therefore, the United States, Canada and other countries have begun to develop group visits for advance care planning and applied to the elders and veterans from Vietnam War. By this way, it improved the completion rate of ACP. In Taiwan, people must pay the consultation fee themselves. It's time consuming and not cost-effective that health care providers have to spend much more time to implement ACP than the regular clinic. Health care agencies may pay less attention on promoting the policy thus may affect the rights of receiving palliative care in the end-of-life. Group visits for advance care planning was implemented in Taipei City Hospital. Through the dynamic of the group visits, people can explore their values and belief and make their advance decision. It is an effective method that can be considered to promote ACP in the future.