癌末病人臨終照護品質指標的探討

To Explore the Indicators of Quality of End-of-Life Care for Patients with Terminally Ill Cancer

高以信(Yee-Hsin Kao) ； 李楊成(Yang-Chang Lee) ； 蔡長松(Chang-Sung Tsai)

《內科學誌》 25卷4期 (2014/08) Pp. 261-266

https://doi.org/10.6314/JIMT.2014.25(4).04

摘要

臨終照護是癌症病人接受醫療照護最後也是最重要的一段照護。本文界定臨終照護是指病人死亡前1個月的照護。癌症病人臨終照護的指標包括，結構面（1項）：有撤除維生醫療提供症狀緩解之藥物及處置的書面資料；過程面（15項）：安寧療護服務要確保持續照護直到病人死亡且提供家屬哀傷輔導，安寧團隊提供哀傷諮詢服務（bereavement counseling）的追蹤，病情告知多久一次，當病人臨終時家屬有想知道更多他們期待（擔心）的資訊嗎？家屬想要知道更多有關病人疼痛用藥的資訊嗎？家屬想要知道更多有關病人呼吸困難處置的資訊嗎？接受化療的比例，求助急診次數大於1次的比例，住院次數大於1次的比例，住院時間大於14天的比例，入住加護病房的比例，使用氣管內插管的比例，使用呼吸器的比例，在病人臨終前7天才接受安寧照護；及結果面（2項）：死亡地點（place of death），醫療花費（cost of health care）。共18項指標，後10項屬於可測量的指標。藉由這些指標的認識與達成，期望醫療照護能完成癌末病人善終的理想。

關鍵字

指標 ； 品質 ； 臨終照護 ； 癌症末期

並列摘要

End-of-life care for patients with terminally ill cancer is an important final part of medical care. We defined the period of end-of-life as the last month of life. In this study, we aimed to determine and apply quality indicators, and whether implementation of these measures translated to improved end-of-life care of cancer patients. Quality indicators for end-of-life cancer included: a) structural domain that provides documentation of a protocol for provision of analgesia and sedation during terminal withdrawal of mechanical ventilation. b)process domain which include home palliative care services that ensure continuous care for the patient until the final moments of life and for the family after the patient's death by helping them deal and cope with the counseling process. c) Outcome domain which include the proportion of patients dying in an acute care hospital and cost of health care.

並列關鍵字

Indicator ； Quality ； End-of-life ； Terminally ill cancer