推動預立醫療自主計畫之宣導－初探

The Promotion of Palliative Care and Advanced Care Planning-A Preliminary Study

王淑貞(Shu-Chen Wang) ； 范聖育(Sheng-Yu Fan) ； 章淑娟(Shu-Chuan Chang) ； 張智容(Chih-Jung Chang) ； 王英偉(Ying-Wei Wang)

《安寧療護雜誌》 18卷2期 (2013/07) Pp. 129-141

https://doi.org/10.6537/TJHPC.2013.18(2).1

摘要

背景：安寧緩和療護在台灣已推動超過20年，並於2009年服務範圍從癌症病人擴展至非癌症病人。安寧緩和醫療條例明訂末期病人可拒絕接受心肺復甦術，而預立醫療自主計畫可讓民眾及早表達意願以達善終。研究目的：本研究目的在探討醫院志工對於生命末期照護與預立醫療自主計畫的看法。材料與方法：橫斷式調查研究，以不記名問卷調查384位志工，對於預立醫囑的看法。依據專家設計「預立醫療自主計畫」手冊，以五次焦點團體訪談10位醫院志工，訪談預立醫囑及手冊內容，作為未來預立醫療自主宣導活動之參考。結果與結論：22.7%的志工已簽署安寧緩和醫療意願書。簽署的主要原因包括：能有尊嚴的離開人間、不要浪費醫療資源、以及不要拖累家人。好處有：讓病人有心理準備、瞭解病人的想法、以及彼此溝通、心靈交流。討論預立醫囑的困難有：病人拒談、不知如何開啟話題、缺乏討論技巧、以及擔心病人負面的情緒。未來可針對討論的好處與困難設計相關介入方案以提升討論意願與簽署比率。

關鍵字

安寧緩和療護 ； 預立醫療自主計畫 ； 社區 ； 志工

並列摘要

Background: The hospice and palliative care movement in Taiwan is more than 20 years, and in recent years it has been spread out from cancer to non-cancer disease. The Hospice Palliative Care Act defines people have right to reject cardiopulmonary resuscitation, and the promotion of advanced care planning (ACP) in the general population becomes important for achieving good death. Purpose: The purpose of this study was to understand the point of view and belief of volunteers about the end of life care and ACP at four counties in Taiwan. Material and Method: A cross-sectional anonymous survey was conducted for the volunteer in the community. There were total of 384 participants in the study. Data were analyzed by descriptive statistics. In addition, five focus group interviews (n=10) were used to explore the contents and process of ACP discussions. Results and Discussion: There was 22.7.0% of the participants who had completed the advance directive document, and the major reasons were death with dignity, do not want to waste medical resources, and reducing burden on family. Benefits from ACP were to prepare in advance, understand the patient's preferences for treatment, and communicate with others be loved. Barrier about ACP discussion were that patients refuse to talk; family do not know how to open this topic, lack of communication skills, and worried patients' negative emotion. It is necessary to develop effective educational material and interventional program for facilitating the ACP discussion.

並列關鍵字

hospice and palliative care ； advance care planning ； community ； volunteer