精神病人預立醫療照護諮商之探討

Advance Care Planning in Patients with Mental Illness

黃卓尹(Cho-Yin Huang) ； 林佳宜(Chia-I Lin) ； 黃鳳嬌(Feng-Chiao Huang) ； 郭千哲(Chian-Jue Kuo) ； 簡瑩佩(Ying-Pei Chien) ； 吳孟璋(Mong-Chang Wu) ； 劉興政(Hsing-Cheng Liu)

《北市醫學雜誌》 17卷附冊 (2020/01) Pp. 21-32

https://doi.org/10.6200/TCMJ.202001/SP_17.0003

摘要

目的：嚴重精神疾病患者，相較於一般人口，較少機會接觸緩和醫療且較少有書面簽署的預立醫療決定。本研究之目的在於探討有精神疾病患者參與預立醫療照護諮商者之特徵，並嘗試找出可能影響其參與預立醫療照護諮商之相關因子，同時探討增加精神病患參與預立醫療決定的可能性。方法：本研究採病歷回顧的方法，收集於2019年1月6日至9月30日於台北市某區域教學醫院參與預立醫療照護諮商且有精神疾病診斷之患者之病歷資料。包含基本人口學資料、精神和生理疾病史，以及預立醫療決定簽署內容和善終意願資料。先以描述性統計方式呈現初步資料，再進一步比較不同性別、和不同精神疾病診斷之間的差異。結果：本研究共收集31位病患，其中17位的診斷為思覺失調症，21位是由住院病房、安置機構或社區復健中心（工作坊）轉介。絕大部分（＞80%）於預立醫療決定中表達拒絕所有維生醫療和流體餵養，簽署動機最多是不想拖累家人，其簽署內容不受性別或精神疾病診斷之影響。思覺失調症患者相較其他患者，平均年齡較輕，有比較大的比例為未婚、無業、在住院或安置中，是透過醫療機構轉介參與諮商。結論：本研究顯示精神病患簽署預立醫療決定的需求可能被忽略，尤以思覺失調症病患更為明顯。後續研究應思考如何提升精神疾病患者參與預立醫療照護諮商，並發展增進精神疾病患者對於預立醫療決定相關法案內容理解的說明方式。

關鍵字

預立醫療照護諮商 ； 預立醫療決定 ； 精神疾患

並列摘要

Objective: Patients with mental disorders are less likely to have written advance health directives. The present study was aimed to describe the characteristics of patients with mental illness who underwent advance care planning (ACP) and their medical decisions regarding end-of-life circumstances in Taiwan. Methods: We recruited patients with mental illness who participated in ACP in Taipei City Psychiatry Center from January 6, 2019 to September 30, 2019. We compared the socio-demographic and clinical characteristics as well as end-of-life medical decisions regarding life-sustaining treatment and receiving artificial nutrition between different genders and diagnoses. Results: A total of 31 patients were included in this study, and 17 of them were diagnosed as schizophrenia. Schizophrenic patients were younger, more likely to be jobless or single and more likely to be referred from a psychiatric facility (ex: psychiatric ward, psychiatric half-way house, psychiatric rehabilitation center) compared to non-schizophrenic patients. Around 80% of patients decided not to receive any life-sustaining treatment and artificial nutrition under certain clinical conditions. No differences regarding advance decision (AD) between schizophrenic or non-schizophrenic patients were noted. Conclusions: Our data presented the characteristics of a sample receiving ACP and suggested that the need for ACP in schizophrenic patients may be neglected. Further study involving larger samples to determine possible factors for people with mental illness to participate in ACP is needed. Interventions that enhance motivation and understanding are also warranted.

並列關鍵字

advance care planning ； advance decisions ； mental illness