- 期刊
從安寧緩和療護視角揭露血液透析病人對末期疾病預立醫療計畫的看法
Explore to Perspectives of Advance Care Planning of End-of-Disease in Patients with Hemodialysis: From View of Hospice Palliative Care
摘要
透析醫療的進步延長了末期腎病病人的存活期，但病人也承受生理、心理、靈性及社會的痛苦，造成負面的生活品質，甚至恐懼死亡，故及早進行「預立醫療計畫」極爲重要。故本研究目的旨在探討血液透析病人對疾病末期預立醫療計畫的看法，針對某醫學中心68位末期腎病接受透析病人，以半結構訪談指引進行面對面訪談；再邀請其中異質性高的14位進行焦點團體。主要研究結果：1)42.6%認爲生活品質比存活期重要；60.3%願意接受醫師病情告知；若治療效果不佳，36.8%想繼續透析，其餘63.2%包括：不會、不一定和沒想過或不知如何作答；心理和行動上皆「死亡準備」做好僅佔10.2%。2)焦點團體結果經分析，所呈現主題爲：「從弱勢到強韌以調適生命困境」、「與疾病共存以延續生命」、「注重身體休養，珍惜生命存活」、「贊同末期病情告知的作用」、「檢視潛在風險與承載力」、「迫近生死關卡，抉擇治療方式」、「覺察生死之終極課題，認同預立醫療計畫」。期望本研究結果能作爲未來推廣安寧緩和療護於末期腎病透析病人之參考，以提昇生命末期的照護品質。
並列摘要
The developing dialysis technology has prolonged survival of patients with end-stage renal disease. However, they who face much suffering from physical, psychological, social, and spiritual impacts, so that trend to a negative quality-of-life, and the terror to death. It is very important to do ”the following advance care planning”. The purpose of the present study is to explore the current opinion of patients with hemodialysis related to advance care planning. The semi-structured guideline is used to the interview survey. 68subjects were enrolled in the quantitative research. Then, 14 heterogeneous subjects participated in a focus group for a deeply interview in the qualitative research. The main results of this study are followed, 1) 42.6% of 68 subjects considered that quality-of-life is more important than prolonging survival. 60.3% agreed with the telling-truth. 36.8% had the intention of continual dialysis. 63.2% included that consider not to dialysis, uncertainty, and no thinking about option or how to answer. 10.3% did the completing earlier preparation on both psychological status and action. 2) Content analysis method was used to analyze the collected data in a focus group. The major findings were 7 themes emerged, as follows: adjustment for dilemma from weakness to strength, maintaining life within the existence of illness, emphasizing on health protection and cherishing life, preferences to the effect of telling-truth in the end-stage of disease, evaluating risks and patients' endurance, making decisions of treatment for ongoing the life struggle, and approving of advance care planning. It is hoped to provide valuable references for promotion of hospice palliative care toward hemodialysis patients with end-stage renal disease, and for enhancing the care quality of end-of-life.