影響安寧共同照護會診之因素探討－以台北市某區域醫院為例

目的：住院之安寧照護（Inpatient palliative care, IPC）團隊的演變對於高齡化社會顯得更為重要，本研究欲分享台北市某區域醫院其影響院內安寧共同照護諮詢會診之因素。方法：本研究使用臺灣版安寧療護篩檢工具（TW-PCST），用於篩檢有潛在安寧療護需求的住院病人。2019年十一月至2021年四月期間大於等於四分者總共1538位，研究統計使用卡方檢定與邏輯式迴歸分析。結果：總分大於等於4分者，仍有84.3%個案沒有會診安寧共照。本院區有諮詢會診院內安寧照顧諮詢團隊的個案，以非癌症之慢性病患為主85.1%。護理師與醫師對於surprise questions之回答有顯著差異性。影響醫師開立共照會診諮詢的因素，包括年齡愈大、TW-PCST分數總分愈高以及醫師認為病人為末期病人為主要之影響因子。結論：影響院內安寧共同照護諮詢會診仍有些障礙出現，非癌症個案之安寧照護需要加強推廣、專科醫師需要進一步的安寧繼續教育、而且醫師與護理師對於病人安寧評估需取得一致性看法。

關鍵字

臺灣版安寧療護篩檢工具；綜合意見；安寧共同照護

並列摘要

Objective: The evolution of the inpatient palliative care (IPC) team has become increasingly important in an aging society. This study aims to share the factors that influence hospice shared-care consultations (HSCC) in a regional hospital in Taipei. Methods: This study used the Taiwanese Palliative Care Screening Tool (TW-PCST) to screen inpatients with potential IPC needs. A total of 1538 patients had a total score greater or equal to 4 from November 2019 to April 2021. The Chi-square test and logistic regression were used for statistical analyses. Results: The results showed that 84.3% of patients who scored 4 points or above did not receive HSCC, and 85.1% of cases who received HSCC were non-cancer chronic disease patients. There was a significant difference between the nursing staff and physicians in response to the surprise questions. Older age, higher total TW-PCST scores, and the physician's perception that the patient was terminally ill were the main influencing factors in physician's prescription of a shared care consultation. Conclusions: Barriers exist and affect the HSCC. The promotion of hospice care for the need of non-cancer cases requires enhancement, and specialists need further continuing hospice education. Moreover, physicians and nurses must reach a consensus on patient hospice assessment.

並列關鍵字

taiwanese palliative care screening tool ； surprise question ； hospice-shared care

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