癌症死亡病患不施行心肺復甦術簽署情形與是否簽署之相關因素分析

The Status of Signing Do-Not-Resuscitate Orders in Terminal Cancer Patients and Analysis of the Related Factors

吳讚美(Chan-Mei Wu) ； 薛爾榮(Er-Jungh Hsueh) ； 鍾春櫻(Chun-Ying Chung) ； 劉慧玲(Hui-Lin Liu) ； 溫怡然(Yi-Jan Wen) ； 鐘裕燕(Yu-Yan Jung)

《安寧療護雜誌》 14卷3期 (2009/11) Pp. 243-253

https://doi.org/10.6537/TJHPC.2009.14(3).1

摘要

本研究目的瞭解癌症死亡病患不施行心肺復甦術文件簽署情形及是否簽署之相關因素分析。本研究以南台灣某區域教學醫院2007年1月至2008年4月癌症死亡病患研究對象，採回溯性式研究設計，即調查病歷，以結構式不施行心肺復甦術文件登錄表收集資料，共得完整資料327位。以SPSS12.0版進行資料建檔與分析。研究結果爲有簽署不施行心肺復甦術相關文件96.9%（316位）、簽署文件爲正式版的佔59.2%（187位）、簽署者爲家屬97.8%（307位）、簽署者與病人關係爲子女65.5%（204位）、解釋者爲醫師44.4%（138位）、簽署距死亡時間0.03年（11天）。影響簽署的主要因子爲科別，血液腫瘤科較非血液腫瘤科高。建議醫護人員可較早與病患及家屬討論不施行心肺復甦術之意願，簽署文件格式及科別皆可爲未來臨床實務推廣與專業人員訓練對象參考。

關鍵字

癌症病人 ； DNR ； 不施行心肺復甦術 ； 預立醫療指示 ； 安寧緩和醫療條例

並列摘要

The purpose of this study was to investigate the status of the implementation of advance directive and to analyze its related factors. This study was a retrospective study of medical record review. The subjects were 327 cancer patients with hospice care in a Southern Taiwan Teaching Hospital from January, 2007 to April, 2008. SPSS for Windows 12.0 was used to analyze the data. The results of the study showed that most 316 (96.9%) of the 327 patients provided informed consent of do-not-resuscitate (DNR) orders in which official version used was 59.2%. Among these patients, the majority 307 (97.8%) of 316 whose consent sheet was signed by family members. The relationship between the patients and their family members who had signed up, offsprings took account for 204 (65.5%) of all relatives. On the other hand, doctors (44.4%) still play the important role to explain and to persuade signing the DNR consent. The time interval between signature and death was 11 days. The major factor that directly impact on signing DNR is the department of patient care, the signing rate is higher in hematology/oncology division than in non-hematology/oncology divisions. It is suggested that encouraging the medical personnel to discuss the DNR consent earlier with cancer patients and their families, the better decision could be made. These factors, as a reference for the clinical practices and educational courses, are to probe into implementing the advance directives for cancer patients.

並列關鍵字

cancer patient ； do-not-resuscitate ； advance directives ； natural death act