安寧共同照護模式試辦經驗

A Preliminary Experience of Hospice Shared-care Model in Taiwan

莊榮彬(Rong-Bin Chuang) ； 李英芬(In-Fen Lee) ； 邱泰源(Tai-Yuan Chiu) ； 王正仁(Jen-Zern Wang) ； 賴允亮(Yung-Liang Lai) ； 蕭淑純(Shu-Chun Hsiao) ； 徐翠霞(Tsui-Hsia Hsu)

《安寧療護雜誌》 10卷3期 (2005/08) Pp. 234-242

https://doi.org/10.6537/TJHPC.2005.10(3).2

摘要

將安寧緩和醫療列為癌症防治中不可或缺的一環，已經是世界先進國家之趨勢。全國癌症防治五年計畫中更訂出目標要使50%之癌末病患接受過安寧緩和醫療服務。然而，台灣目前卻只有17%之癌末病患曾接受安寧緩和醫療服務。因此，應該在過去施行有年之安寧住院與居家模式之外，加入共同照護模式，將安寧緩和醫療服務擴展至非安寧病房乃至全醫院，方可能達成目標。為了累積安寧共同照護模式在醫院推行的經驗以設計出可全國推行方案，93年國民健康局委託安寧照顧協會於全國八家已設立安寧病房，並具有相當經驗之醫院進行試辦計畫共計六個月。總計收案741人，服務1518次，有五成個案指訪視一次。照會科別以血液腫瘤科(38.5%)、腸胃科(13.5%)及放射腫瘤科(11.7%)為主。服務次數中以症狀控制(57%)，家屬心理社會問題(53%)及病患心理社會問題(41%)佔大宗。結案原因以安寧病房(44.7%)最多，在原單位照顧至症狀改善、死亡及出院佔38.2%。本試辦計畫初步驗證了安寧共同照護模式之可行性，並提供了相當寶貴之執行經驗可供擬定全國推廣計畫之參考。計畫中發現之問題有：1．轉介時問太晚，2．個案來源及中少數科別，3．心理社會問題需要加強相關人力，4．安寧共同照護模式需有安寧住院及居家模式之支援。

關鍵字

安寧共同照護

並列摘要

It has been a worldwide trend to recognize that hospice-palliative care in the context of the National Cancer Strategy. In the National Cancer Strategy of Taiwan, 2004-2008, the goal of hospice coverage rate has been set at 50%. To triple the present coverage rate to reach the goal, it is necessary to implement a new model other than in-patient and home care, the hospice shared-care model. That is, set up a hospice-palliative care team to provide consultation and service to terminal cancer patients outside the hospice-palliative care ward. To accumulate the experience of hospital palliative care team and propose a nationwide project, the Bureau of Health Promotion sponsored a 6-months' project to implement the hospice share-cared model in eight hospitals with hospice-palliative ward. There were 741 patients referred to the palliative care teams and 1518 visits were made. 52.8% patients was visited only one time. Most of the patients were referred from hemato-oncologist (38.5%), Gastro-enterologist (13.5%) and Radioncologist (11.7%). The most frequent services provided were symptom control (57%), psychosocial problems of family (53%) and psychosocial problems of patients (41%). There were 44.7% of patients transferred to hospice-palliative ward and 38.2% of patients stayed in previous ward till death, discharge or improvement of symptom. The result of the project provides experiences to implement a hospice shared-care model and approves the feasibility of a larger nationwide project.

並列關鍵字

hospice shared-care ； palliative care team