生命末期照顧如何達到好的成本效益

How to Optimize Cost-Effectiveness in End-of-Life Care

黃馨葆(Sin-Bao Huang) ； 蔡兆勳(Jaw-Shiun Tsai) ； 陳慶餘(Ching-Yu Chen) ； 邱泰源(Tai-Yuan Chiu)

《安寧療護雜誌》 16卷2期 (2011/07) Pp. 205-216

https://doi.org/10.6537/TJHPC.2011.16(2).5

摘要

根據世界衛生組織的建議，生命末期照護的首要目標是生活品質的提昇，而不是極盡的延長生命，因為這個目標已經難以達成。試圖延命的醫療措施在末期病人經常變成所謂的無效醫療，病人在醫療過程中飽受痛苦，醫療資源的使用更是可觀。安寧緩和醫療是提供有生命威脅的病人與家屬，從診斷到死亡的疼痛及其他症狀的緩解、心理和靈性的支持與悲傷輔導，其目標是提昇生活品質。根據國內外的經驗與實證，提供末期病人安寧緩和醫療確實能緩解身體症狀、減緩心理情緒反應、提升內在力量減少死亡恐懼，改善生活品質，繼而達到善終。本文章藉由文獻回顧，從病人之成本、家屬及照顧者之成本與醫療體系之成本三方面做醫療成本探討，著重症狀控制、心理情緒、病人及家屬之生活品質、滿意度等面向。安寧緩和醫療不僅有好的照顧品質，還能節省醫療資源的使用，對末期病人的照顧能達到較佳的成本效益。（安寧療護 2011：16：2：205-216）

關鍵字

緩和醫療 ； 生命末期照顧 ； 成本效益

並列摘要

According to WHO, the major goal of end-of-life is improving life quality instead of prolonging life for as long as possible. The effort put into prolonging life for as long as possible in the terminally ill often results in extending the patients' suffering, at the same time consuming a lot of medical resources, but the processes are often futile.The goal of palliative care is to improve the quality of life of patients facing life-threatening illness and their families. The approach includes the prevention and relief of pain and other physical symptoms, psychosocial and spiritual suffering since the diagnosis of the disease. Our experiences and current literature indicate that palliative care during end-of-life indeed improves physical symptoms as well as emotional distress, decreases the fear for death by strengthening the inner power, and as a whole improves the quality of life, hence achieving the goal of 'having a good death'.We reviewed current evidence and evaluated the cost effectiveness of palliative care from three dimensions: cost to the patient, cost to the family members and caregivers, and cost to the health care system. The effect evaluations were symptom control, the quality of life, patient and family satisfaction, and the feelings of patients and families facing end-of-life. In conclusion, palliative care is cost-effective and provides good quality of care for those in the end-of-life. (Taiwan J Hosp Palliat Care 2011:16:2:205-216)

並列關鍵字

palliative care ； end-of-life care ； cost-effective