居家生命末期照顧新思維：以台大醫院金山分院社區居家安寧為例

A Novel Thinking of End of Life Care- A Home Based Palliative Care Modle of National Taiwan University Hospital Jin Shan Branch

翁瑞萱(Ruey-Shinuan Ueng) ； 施至遠(Chih-Yuan Shin) ； 洪香蓮(Shiang-Lien Hung) ； 劉旭華(Hsu-Hua Liu) ； 李佩璇(Pei-Hsuan Lee) ； 洪毓謙(Yu-Chien Hung) ； 賴俊夫(Chun-Fu Lai) ； 趙家德(Chia-Ter Chao) ； 劉嘉仁(Chia-Jen Liu) ； 黃勝堅(Sheng-Jean Huang) ； 徐愫萱(Su-Hsuan Hsu)

《安寧療護雜誌》 20卷3期 (2015/11) Pp. 258-268

https://doi.org/10.6537/TJHPC.2015.20(3).4

摘要

國人對於生命末期照護的需求隨人口高齡化而逐年增加，但在台灣仍只有少數末期病人曾接受安寧照護服務，其中又以接受住院安寧療護為主。而過去在台灣的相關研究顯示，生命末期時能在宅往生是大多數人的意願，因此建構社區安寧照護體系，讓末期病人能依其意願在社區接受生命末期照護、在宅善終，為當前重要的議題，方能符合社會的需求。台大醫院金山分院自2012 年開始發展社區安寧照護模式，本文藉由照顧一位末期病人的經驗，闡述本院的社區安寧照護模式，在此照護模式下累積照護經驗，建構出生命末期照顧歷程，此歷程以病人為中心，區分為決策期、穩定期、瀕死期與悲傷撫慰期，每一時期依據病人與家屬的需求而有不同的照護目標。同時本文也就世界各國發展社區安寧療護的趨勢，與國內推動社區安寧療護的現況加以探討。期望透過台大醫院金山分院建立社區安寧照護模式的經驗，能有助於本土化社區安寧照護的推展，以提升生命末期照護品質。

關鍵字

生命末期 ； 居家照顧 ； 安寧療護 ； 社區安寧 ； 悲傷撫慰

並列摘要

The demand of end-of-life care is increasing with the treand of aging poupuiaotn in our country, but only few patients with terminal illness have ever received pailliative care which is mostly hostpial-based. Presvious study have demonstrated that most terminally ill patients prefer to die at home in Taiwan. Therefore, it is an important issue to establish a system of community-based palliative care that can provide end-of-life care for patients who wish to be cared and to die at their communities. We start to develop the model of community-based palliative care in National Taiwan University Hospital Jin-Shan Branch since 2012 and in this articale, we introduce this model by presenting a case who received our palliative home care service. Through the experiences of this model, we divide the process in end-of-life care into four phases-decision making phase, stable phase, pre-dying phase, and bereavement phase. The care goal of each phase is differenent based on needs of terminally ill patients and their families. In addition, this article investigates current developement of community-based palliative care in other countries and in Taiwan. Our experience may be helpful to promote the community-based palliative care in Taiwan that improves the quality of end-of-life care.

並列關鍵字

end-of-life ； home care ； palliative care ； community-based palliative care ； bereavement care

參考文獻

行政院衛生署。生命統計。台北市：行政院衛生署，2010。

Tang ST, When death is imminent: where terminally ill patients with cancer prefer to die and why. Cancer Nurs 2003; 26: 245–51.

Tang ST, Huang EW, Liu TW, Rau KM, Hung YN, Wu SC. Propensity for home death among taiwanese cancer decedents in 2001-2006. JPSM 2010; 40(4), 567-74.

翁瑞萱、徐愫萱、洪香蓮等。台灣的末期病人有機會壽終正寢嗎?─在宅往生課題之探討。安寧療護 2014；18(3): 320-29。

Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting. J Palliat Care Med 2011; 14(1): 17-23.