癌末病人安寧共同照護之照會

Palliative Care Consultation in Terminal Cancer Patiens

高綺吟(Chi-Yin Kao) ； 邱泰源(Tai-Yuan Chiu) ； 胡文郁(Wen-Yu Hu) ； 陳慶餘(Ching-Yu Chen) ； 賴明坤(Ming-Kuen Lai) ； 陳月枝(Yueh-Chih Chen)

《台灣醫學》 11卷6期 (2007/11) Pp. 602-611

https://doi.org/10.6320/FJM.2007.11(6).02

摘要

行政院衛生署國健局於2005年始推動安寧緩和醫療照護團隊與原診療團隊之安寧共同照護模式，期望藉由共同照護模式的功能將安寧療護的癌末病人照護理念推廣到非安寧病房，以及提供相關諮詢服務。本研究旨在暸解癌末病人照會安寧共同照護之現況，作為未來提供安寧共同照護之參考。自2005年11月至2006年5月止，採問卷調查法，於北臺灣某醫學中心進行。共收案50位照會安寧共同照護的癌末病人。研究工具包括基本屬性資料、症狀困擾量表、醫院焦慮憂鬱量表、靈性安適狀態量表以及社會支持量表，從照會共同照護名單中，選取符合收案條件的病人，進行面對面訪談，以SPSS11.0版進行資料分析。結果發現照會共同照護癌末病人呈現生理、心理、靈性、社會層面及病情告知等多面向照護問題，其中前三項照會問題分別為心理問題(62%)、生理問題(60%)以及病情告知(32%)。心理問題為「疑似憂鬱」狀態（平均分數為9.54分）；生理問題則以疲倦、口乾、疼痛、呼吸困難及腹脹發生頻率最高，生理問題的困擾度自高而低的排序分別為大小便失禁、腹水、疲倦、食慾不振與腹脹。癌末病人教育程度較低者，其憂鬱程度較高；有宗教信仰者之靈性安適狀態的無形力量支持較佳；已婚者有較佳之實質社會支持度。此外，癌末病人之症狀總數、不確定感、焦慮及憂鬱間呈正相關；而「焦慮及憂鬱」均與「靈性安適狀態」呈負相關；不確定感與病情了解度呈負相關。故由醫師、護理師、心理師、社工師、牧靈人員與志工等安寧照護成員與原醫療照護團隊成員共同組成安寧共同照護醫療團隊，解決非安寧病房癌末病人遭遇到難以處理的各層面問題與困境，提升癌末病人末期生活品質，以達善終，是當今臨床實務提昇末期照護品質迫切且重要的推展工作。

關鍵字

安寧共同照護 ； 癌末病人 ； 憂鬱

並列摘要

For patients with terminal cancer in non-palliative units to have palliative care, Bureau of Health Promotion implemented hospital-based palliative care team project in 2005. This care model combined with hospice care team and original medical team to provide cancer patients related service. The primary target of this study was to survey the terminal cancer patients consulted hospital-based palliative care team. Fifty eligible terminal cancer patient's data was collected during 2005 Nov. to 2006 May in a medical center in north of Taiwan. Using the questionnaires include demographic information, Symptom Distress Scale, Hospital Anxiety and Depression Scale, Spiritual Well-Being Scale and Social Supportive Scale in a medical center. Statistical analysis was used SPSS 11.0. The top three needs of patients with terminal cancer were psychological care (62%), physical care (60%), and truth telling (32%). Depression was a significant symptom in psychological section. General physical symptoms included fatigue, dry mouth, pain, dyspnea, and abdominal distention. Physical distress symptoms were feces and urine incontinence, ascites, fatigue, appetite loss, and abdominal distention. Terminal cancer patients with low education level had higher depression degree. Spiritual-well-being was better in patients having religious belief. Social support was better in married patients. Amounts of symptoms, uncertainty, anxiety and depression were positively correlated. ”Anxiety and depression” and ”spiritual well-being and social support” were negatively correlated. Uncertainty and truth telling were negatively correlated. Therefore the hospital-based palliative care team included palliative care physicians, specialist nurses, psychiatrist, social workers, and pastoral care workers to satisfy the terminal cancer consulted patients' caring need and assist those solving their problems.

並列關鍵字

hospital-based palliative care team ； terminal cancer patient ； depression