探討推動安寧療護之障礙因子及其應對策略建議

Barriers in Promoting Hospice Palliative Care and Its Relevant Management Strategies

謝秋菊(Chiu-Chu Hsieh) ； 李麗雲(Li-Yun Lee) ； 周繡玲(Hsiu-Ling Chou) ； 簡淑慧(Sui-Whi Jane)

《腫瘤護理雜誌》 12卷2期 (2012/12) Pp. 51-59

https://doi.org/10.6880/TJON.201212_12(2).05

摘要

近30年來癌症一直是台灣十大死因的首位，癌症照護是衛生單位及醫療團隊重視的議題，初期癌症治療以「治癒」（Cure）為目標，但當疾病進展至末期時，則須改以提供身、心、靈舒適之「安寧療護」照護（care）為主，以提高病人及家屬生活品質。雖然安寧療護初期以「癌症末期病患」為主要收案對象，經過社福機構及醫療團體積極爭取，政府已新增「八類非癌疾病」病人也納入「安寧照護」服務；然而安寧療護在台灣的利用率仍偏低，因此如何有效推廣「安寧照護」是刻不容緩的事。本文針對民眾、醫護人員及政策面分別探討其可能之促進或障礙因素，發現民眾對於安寧療護之認知及態度與死亡、文化、經驗、態度、信念及恐懼感有關；醫護人員在協助病人接受安寧照護時，常面臨自身未做好準備、缺乏臨床教育訓練、心理障礙、對瀕死病人照護知識及技能不足等問題；另外，政府相關政策制度及經費補助，亦會影響安寧療護之推動，因此，建議臨床實務、教育、政策及研究等層面訂定相關應對策略以為推動安寧療護之參考，期望安寧療護能普遍應用於臨床工作中，進而提昇病人及家屬之照護品質。

關鍵字

安寧療護 ； 不接受心肺復甦術 ； 障礙因子 ； 應對策略

並列摘要

Cancer in the past 30 years has been the first of the ten leading causes of death in Taiwan. Care for cancer patients is one of the important isuues regarded by health care institutions. The treatment goal of early stage cancer is to cure the patents. However, as the disease progresses to the terminal stage, the major goal of the treatment has to move to the provision of hospice care, that improve the patients' physiological, psychological, and spiritual comfort, and quality of life. Although the early development of hospice care is primary for terminal stage cancer patients, the social welfare and medical institution actively seek the hospice care needed to extend to eight categories of non-cancer diseases. Due to the low utilization of hospice care in Taiwan, the purpose of this paper was to explore the factors that enhance or hinder hospice care from different aspects, including the patients and their families, medical staff and government's policies. Over all, the authors found that the awareness and attitudes toward hospice care in patients and their families were different from culture to culture, from, their life experiences, religions and fear toward death. The promotion of hospice service is restricted if the medical staffs are ill prepared, lacks of education and training about hospice care and lacks of knowledge or skill in taking care of dying patients, and have unsolved psychological barriers. Furthermore, government's policies and budget also affect the promotion of hospice services. Thus, the authors suggest that in the future, the relevant strategies have to be set from clinical practice, education, research, and policies to increase the implementation of the hospice services, enhancing the quality of life for cancer patients and their families.

並列關鍵字

hospice palliative care ； do not resuscitation (DNR) ； barriers toward to hospice care ； management strategies