摘要
緩和醫療照會是收治住院病患與溝通安寧理念的的重要途徑，而國內有關此方面之研究有限，本研究以北部某醫學中心初次安寧照會的219位癌症患者為對象，進行訪談紀錄。研究對象平均年齡為63.1歲，結果發現照會來源以院內其他病房最多(57.1%)，其次是急診(17.4%)和門診(16.9%)。癌症原發部位以肺癌(20.1%)、肝癌(18.7%)和結腸直腸癌(11.4%)居多。最初要求照會者包括醫護人員(79.5%)、家屬或照顧者(46.1%)，而病患本人只佔5.0%。病人親自參與之會談只佔39.3%，而協談者身份依序為兒女(65.0%)、配偶(40.4%)、媳婦或女婿(13.3%)。申請照會目的主要是病患身體症狀的控制(79.0%)，困擾病人的症狀包括疼痛(68.0%)、呼吸困難(34.7%)、疲倦虛弱(32.4%)等，嚴重程度幾乎都在中度以上。照會時病人意識狀態清醒者有60.3%，溝通能力正常者約佔半數(51.6%)。知道診斷的病人有68.5%，但確知預後的只有38.8%。雖有76.7%的病人已表達不做心肺復甦術，但絕大多數(81.3%)的病人仍未選定死亡的場所。在認知態度方面，會談前30.2%的病人完全不瞭解安寧緩和醫療，會談後則有72.1%的病患完全或大致接受；家屬則有過半數(53.7%)在會談前已完全或大致瞭解，會談後則高達95.1%的比例完全或大致接受。會談後同意書完成簽署158份，簽署率有72.1%，但其中病人親自簽署的同意書只佔13.9%。病人參與會談組有29.5%的同意書由病人簽署，沒有參與會談組中病人簽署的同意書只佔4.1%。最常簽署同意書者為兒女(86.4%)，其次是配偶(41.6%)。由本研究顯示台灣末期照護之決策傾向以家庭為導向，如何進行本土化倫理決策值得進一步探討。
並列摘要
Consultation for hospice care is the main way for hospice admission and provides an opportunity to communicate the hospice principles. We collected a total of 219 terminal cancer patients with initial consultation for hospice care in a medical center of Northern Taiwan. The average age of patients is 63.1 years old and they came from other wards (57.1%), emergency room (17.4%) and outpatient clinics (16.9%). The common primary sites of cancer are lung (20.1%)、liver (18.7%) and colon-rectum (11.4%). Hospice consultation was requested by medical staff (79.5%) and patients' family (46.1%), but only 5% by patients themselves. Only 39.3% of patients participated in the consultation discussion. This result revealed that family members and medical professionals dominate the decision making over the patient itself. Those who participated the consultation were patients' offspring (65.0%), spouse (40.4%), son or daughter in law (13.3%). The main purpose of consultation was for symptom control (79.0%). The symptoms that bothered patients most which evaluated by the consultant were pain (68.0%), breathless (34.7%), fatigue and weakness (32.4%), and etc. The severity of most symptoms was more than moderate degree. Patients with clear consciousness were 60.3% and among all patients half of them (51.6%) could communicate normally. There are 68.5% of patients knowing their diagnoses but only 38.8% of patients understood their prognosis. The patients who refused CPR are 76.7%, but the majority of all patients (81.3%) hadn't decided the place of death. Patients with no knowledge of hospice before consultation were 30.2%, but after consultation 72.1% of patients were able to accept palliative care. More than half (53.7%) of patients' family had complete knowledge of hospice before consultation and nearly all patients' family (95.1%) accepted it after consultation. Total of 158 (72.1%) informed consent were signed by patients or their family. Only 13.9% of consents were signed by patients themselves. Others were often signed by patients' offspring (86.4%), and followed by their spouse (41.6%). From above results, we concluded that the end-of-life decision making in Taiwan was related to the family-oriented culture.