醫務社工在預立醫療照護諮商之角色建構

Role Establishment of Medical Social Workers in Advance Care Planning

林素妃(Su-Fei Lin) ； 蔡佳容(Chia-Jung Tsai) ； 陳香岑(Siang-Cen Chen) ； 林秋蘭(Qiu-Lan Lin) ； 王美几(Mei-Chi Wang) ； 朱偉汝(Wei-Ju Chu) ； 蔡宗達(Zong-Dar Tsai) ； 黃遵誠(Tsun-Cheng Huang) ； 洪士奇(Shih-Chi Hong)

《北市醫學雜誌》 17卷附冊 (2020/01) Pp. 49-58

https://doi.org/10.6200/TCMJ.202001/SP_17.0006

摘要

目的：探討醫務社工在預立醫療照護諮商之工作經驗，彙整意願人的問題與經驗，瞭解醫務社工角色，並作為未來工作之參考。方法：運用焦點團體討論法，回顧醫務社工的臨床工作，相互討論收集經驗。結果：研究發現民眾與意願人在不同時間點所關注的焦點有所不同，已在疾病中的意願人更有想法也期待盡早完成諮商；針對心智能力缺損或表達障礙的意願人，需有更充分之事前準備與配套措施。最後，醫務社工在預立醫療照護諮商（Advance Care Planning, ACP）中扮演了宣導與啟發者、準備者、引導對話與溝通者、行政協調與倡議者的角色。結論：應從政策面進行宣導，建立本土化的預立醫療照護諮商指引，發展客觀臨床能力測驗（OSCE），支持醫務社工在ACP的貢獻，建構完善的醫務社工教育訓練，並針對特殊族群ACP規畫完善的配套措施。

關鍵字

病人自主權利法 ； 預立醫療照護諮商 ； 預立醫療決定 ； 醫務社工

並列摘要

Purpose: To study the work experience of the medical social workers in Advance Care Planning (ACP), to collect all the questions and experiences from the clients, and to understand the role of medical social workers as the reference for future work. Method: The focus group discussion was applied to review the clinical work of the medical social workers, discuss mutually, and collect experiences. Result: The study showed that the people and clients focued on different matters at different point of time, while the clients who have been suffering from illnesses have their own ideas and are looking forward to completing the consultation as soon as possible. As for the clients who are mentally or language disabled, sufficient preparation and supplementary measures are even more necessary. Last but not the least, medical social workers play the roles in ACP to promote, inspire, prepare, guide the conversation, communicate, administrate, coordinate, and advocate. Conclusion: It should be propagated from the policy aspect, to establish localized guidance for ACP, develop Objective Structured Clinical Examination (OSCE), support the medical social workers' contribution to ACP, build comprehensive education and training for medical social workers, and plan sound ACP supplementary measures for special population.

並列關鍵字

patient right to autonomy act ； advance care planning (ACP) ； advance decision (AD) ； medical social worker