社區慢性病長者參與預立醫療照護諮商之困境與挑戰

國內高齡慢性病長者因COVID-19疫情發展成重症，進而死亡是目前國內重要的照護議題。快速進展的病況以及高死亡率，讓國人開始重視及早介入預立醫療照護諮商（advance care planning, ACP）之重要性與必要性，以提供符合病人期待之醫療照護。儘管ACP被證實能改善末期照護品質，但因應防疫政策導致國內以醫院門診為主之ACP服務量下降，發展以社區為導向之ACP服務可能解決此限制，但國內相關研究甚少。故本文提出社區慢性病長者參與ACP之急迫性，並且探討執行上可能面臨之挑戰與建議。結果發現以社區為導向ACP之挑戰與困境為：（1）考量社會文化脈絡；（2）促進長者對ACP之感知與覺察以及（3）建立彈性且創新之支持性醫療環境。期待藉此做為後疫情時代發展社區慢性病長者ACP臨床服務、教育及研究之基石。

關鍵字

嚴重特殊傳染性肺炎；慢性病長者；預立醫療照護諮商；社區高齡照護

並列摘要

Caring for older adults with chronic illnesses who have developed serious illnesses and subsequently died because of COVID-19 is a crucial healthcare issue in Taiwan. Rapid disease progression and high mortality of these patients make the citizens attach importance and necessity of early introduction of advance care planning (ACP) to this population to provide goal-concordant care. Although the evidence showed that ACP could improve the quality of end-of-life care, the number of ACP services primarily for hospital clinics has been decreasing due to the government policy for controlling the COVID-19 pandemic. The development of community-based ACP services may overcome the limitation. However, the relevant studies are sparse in Taiwan. Therefore, this article highlights the urgency of early ACP engagement among older adults with chronic illness, followed by exploring the potential challenges while delivering ACP. The key facilitators for successful ACP implementation in the community were identified: (1) considering social and cultural context while delivering ACP; (2) facilitating the perception and awareness of early ACP engagement for older adults and; (3) building up a flexible, creative, and supportive healthcare environment. The reflection of this article could be used to inform further clinical practice, staff training, and research about community-based ACP services for older adults with chronic illness.

並列關鍵字

COVID-19 ； chronic illness elderly ； advance care planning ； community-based elderly care

國際替代計量

社區慢性病長者參與預立醫療照護諮商之困境與挑戰

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