重症病童家屬簽署不施行心肺復甦術之相關因素探討

本研究目的為瞭解重症病童家屬在醫病共享決策下，對不施行心肺復甦術（Do Not Resuscitation, DNR）的現況及其相關因素探討。採用橫斷面、相關性研究設計，採方便取樣，研究對象為中部某醫學中心之兒童加護病房入住病童之家屬共100位。利用結構式問卷、醫病共享決策量表及病歷查閱方式收集資料。結果發現：在醫病共享決策下，收案病童病歷完成DNR註記者佔16.1%。重症病童家屬的醫病共享決策得分平均分數40.5分（SD=5.2），顯示重症病童家屬其對醫病共同決策得分高。重症病童家屬屬性在教育程度（大專或大學以上／高中職以下）（p =.00）對簽署不施行心肺復甦術呈現顯著差異；病童住院次數對簽署不施行心肺復甦術呈現顯著差異（p=.02）；使用邏輯斯迴歸模式分析不施行心肺復甦術的相關預測因素，發現重症病童家屬的教育程度（p＜.01）及病童住院次數達統計顯著意義（p＜.05）。本研究結果能提供臨床醫療人員瞭解影響父母簽署不施行心肺復甦術決策的相關因素，建議未來醫療團隊在落實醫病共享決策時，應考量重症病童住院的次數及其家屬教育程度的個別性，以提供重症病童家屬選擇最佳治療方案，亦提供我國兒童加護病房末期病童照護政策上的參考。

關鍵字

重症病童家屬；不施行心肺復甦術；醫病共享決策

並列摘要

This study explored the factors responsible for family members making a do-not-resuscitate (DNR) decision for their critically ill children under the shared decision-making process between doctors and patients. This cross-sectional correlational study included 100 family members of children who presented to the pediatric intensive care unit of a medical center. Data were collected using structured questionnaires, shared decision-making scales for doctors and patients, and medical records. The results revealed that 16.1% of the critically ill children's medical records had completed DNR annotations. A high average score of 40.5(SD=5.2) was obtained for shared decision-making between doctors and family members of critically ill children. A significant difference was observed in the educational level (college or above and vocational high school or below) of family members (p= .00). A significant difference in the number of hospitalizations was observed among critically ill children with different attributes. A significant difference was observed between the two groups, that is those who made a DNR decision and those who did not (p= .02). The logistic regression model was used to analyze the predictors of a DNR decision. The results indicated that the education level of family members (p＜ .01) and the number of hospitalizations of critically ill children (p＜ .05) reached statistical significance. These results provide clinical personnel with an understanding of the factors that affect the DNR decision for parents. Therefore, medical teams should consider the number of hospitalizations of critically ill children and the education level of the family members during the shared decision-making process. Moreover, the results will facilitate the development of the best treatment plans and care policies for critically ill children presenting to pediatric intensive care units in my country.

並列關鍵字

family members of critically ill children ； do not resuscitate ； shared decision-making

參考文獻

吳俊穎、賴惠蓁、陳榮基（2010）･不施行心肺復甦術之相關法律議題･臺灣醫界， 14（3），318-323。

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蕭淑方、梁嘉凌、江迎星、楊百能（2016）･影響生命末期兒童的父母緩和醫療決策的因素･彰化護理雜誌，23（4），55- 66。

Burns, J. P., Sellers, D. E., Meyer, E. C., Lewis- Newby, M., & Truog, R. D. (2014). Epidemiology of death in the pediatric intensive care unit at five U.S. teaching hospitals. Critical Care Medicine, 42(9), 2101-2108.

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