重度巴金森氏症溝通困難個案的預立醫療照護諮商－個案報告

Advance Care Planning in Severe Parkinsonism with Communication Difficulties: A Case Report

孫馥敏(Fu-Min Sun) ； 劉靜女(Ching-Nu Liu) ； 廖珮琪(Pei-Chi Liao) ； 林怡杏(Yi-Shing Lin) ； 章琇惠(Hsiu-Hui Chang) ； 朱彩鳳(Tsai-Feng Chu) ； 李宜蓉(Yi-Rong Li)

《北市醫學雜誌》 17卷附冊 (2020/01) Pp. 42-48

https://doi.org/10.6200/TCMJ.202001/SP_17.0005

摘要

病人自主權利法中提及所有意識清楚具決定能力的成年人都可以透過參與預立醫療照護諮商，決定自己的醫療照護和善終的權利，為自己的末期醫療照護預做規劃，本文分享諮商團隊協助一位具溝通障礙的巴金森氏症病人進行預立醫療決定的諮商經驗，以個案報告方式呈現，透過回顧協助本案進行諮商的團隊人員之經驗，藉由敘事分析的方式，發現個案與家屬的生活經驗以及諮商團隊的專業養成背景有助於引導緩和照護議題的討論等影響諮商進行因素，另外諮商團隊在諮商進行時需要協助個案確實進行意見的表達，適時搭配圖像、工具等予以輔助，並且給予充份的時間讓個案進行理解、分析與表達等因應方式，藉此以協助醫療團隊和社會大眾瞭解意識清楚但具有溝通障礙者在醫療自主上的想法、需求和期待，並加以重視，進而對於未來諮商方式與內容提供建議，讓更多的是類民眾有機會和管道參與預立醫療照護諮商釐清自己的價值和期待並完成由自己作主的預立醫療決定。

關鍵字

預立醫療照護諮商 ； 預立醫療決定 ； 溝通過程 ； 溝通困難

並列摘要

Patient Right to Autonomy Act mentions that all adults who are clear and capable of decision-making can participate in Advanced Care Planning to decide their own medical treatment and to plan their end-of- life care. This article is to share the experience about how consulting team assist a patient with communication difficulty and his family members to make Advanced Care Planning. We analyzed the results through narrative analysis in order to find out the factors that affect planning process, such as the life experience of the patient and his family member and the professionalism of the consulting team. We also give suggestions to the consulting team about how to assist the patient to express his decision, such as using pictures or adequate assistive devices and preserving enough time for him to understand the message and deliver his thoughts. We hope this article can raise the awareness of members in consulting team and general public about the importance to meet the needs and expectations of those who are cognitively intact but have communication barriers in declaring their medical autonomy. Furthermore, we also provide ways for consulting team to adjust communication process and consulting model for patients with communication difficulty in the future. This article aims to promote that consulting team can help more people who are cognitively intact but suffer from communication difficulty and increase the opportunity for them to participate in Advanced Care Planning to clarify their own values and expectations and to complete the Advance Decision.

並列關鍵字

advance care planning ； advance decision ； communication process ； communication difficulty