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精神疾病患者對於預立醫療照護諮商與預立醫療決定之認知、態度、影響因素與意向
Perceptions, Attitudes, Influencing Factors and Intentions of People with Mental Illness toward Advance Care Planning (ACP) and Advance Decision (AD)
摘要
為探究精神疾病患者對於《病人自主權利法》、預立醫療照護諮商（ACP）與預立醫療決定（AD）之認知、態度、影響因素與意向，本研究以中部縣市一所精神醫療機構附設之社區復健中心與康復之家，其所服務之成年慢性精神疾病患者為對象，採問卷調查與焦點團體訪談方式蒐集量化與質性資料，有效問卷計有90份，焦點團體則有10位受訪者參與。研究結果顯示，受訪者對於病主法、ACP與AD之認知與理解仍有不足，雖對於ACP與AD多抱持正面態度與看法，惟疾病標籤與烙印之影響仍值得關注；其次，善終與尊嚴、末期醫療的自主性，以及避免家屬的決策壓力、意見衝突與經濟負擔等，是受訪者進行ACP與AD的主要考量與影響因素；再者，多數受訪者雖有意願接受ACP與AD，惟實際完成簽署者仍屬少數。研究建議藉由多元形式與管道進行宣導、運用充權（empowerment）服務策略強化精神疾病患者的權利意識，以及藉由家屬或關係人的溝通、參與及配合，提升精神疾病患者進行ACP與AD之意願與動機。
並列摘要
In order to investigate the perceptions, attitudes, influencing factors, and intentions of people with mental illness of the Patient Right to Autonomy Act, ACP, and AD, this study took the adult patients with chronic mental illness in the community-based rehab centers and rehabilitation homes attached to a psychiatric institution in a town in central Taiwan as the research subjects. The study collected quantitative and qualitative data through individual questionnaires and focus group interviews, with 90 valid questionnaires and 10 respondents in the focus group. The results of the study showed that the respondents' perceptions and understanding of the Patient Right to Autonomy Act, ACP and AD were still insufficient. Although most of the respondents had positive attitudes and views towards ACP and AD, the influence of disease labeling and stigma was still a cause for concern; secondly, hospice and dignity, the autonomy of end-stage medical care, and avoidance of decision-making pressure, different opinions and financial burden for family members were the main considerations and influencing factors for the respondents' decision-making regarding ACP and AD; and furthermore, although most of the respondents were willing to accept ACP and AD, only a few of them actually signed the agreement. It is suggested at the end of the paper that multiple forms and channels of advocacy should be utilized to strengthen the awareness of the rights of people with mental illness by using empowerment service strategies. The willingness and motivation of people with mental illness to engage in ACP and AD should be enhanced through the communication, participation, and cooperation of their family members and related persons.