外科重症病患生命末期CPR意願與家屬醫療決策之探討

Decision Making for End-of-Life Care by Surgical Critically Ill Patients and Their Families

洪韡倢(Wei-Chieh Hung) ； 邱秀渝(Shiu-Yu C. Katie Lee) ； 洪芳明(Fang-Ming Hung)

《安寧療護雜誌》 21卷3期 (2016/11) Pp. 258-272

https://doi.org/10.6537/TJHPC.2016.21(3).2

摘要

研究目的：探討家屬對於外科加護病房生命末期病患心肺復甦術(Cardiac PulmonaryResuscitation, CPR)意願與家屬決策。材料與方法：運用描述性研究，採用家屬與病人的人口學及決策資料表，採方便性取樣於北部兩所醫學中心的外科加護病房去世病人之家屬為收案對象，收案期間為2008 年3 月到2009 年3 月。結果：(1)137 位家屬參與研究、70.1%是兒女、89.1%簽署DNR。(2)剛入ICU 時39.4%家屬希望CPR、46%不希望CPR、14.6%未曾想過這個問題，不論家屬希望或不希望CPR，最後兩組皆超過8 成的家屬簽署DNR。(3)有表示DNR 意願之病人有19.7%，若病人曾表示DNR 的意願，則家屬會傾向選擇DNR。結論：外科重症病人與家屬經常還來不及討論生命末期意願時，就面臨死亡議題，由家屬在代理決策是困難的。因此，推行生命末期臨終照護與安寧療護概念，病人的預立安寧意願書並與家屬討論，就更顯得重要。

關鍵字

不施行心肺復甦術 ； 心肺復甦術 ； 加護病房 ； 末期病人 ； 醫療決策

並列摘要

Purpose : The aim of this study was to discuss about the decision making of a DNR order by the patient's family as the patient's surrogate while facing the end of the patient's life in the surgical ICU. Method: A descriptive research study was conducted based on patients' and families' demographics and decision-making forms. A convenience sample of patients and their families from two medical center surgical ICU units was taken from March 2008 to March 2009. Results: (1) 137 patient's families were included in this study. 70.1% of these 137 family members were the children of the patients. 89.1% signed DNR consent forms. (2) When the patients were admitted to the ICU, 39.4% of patient's families wish for CPR, while 46% do not wish for CPR, and 14.6% have never considered CPR. (3) 19.7% of patients have previously expressed wishes for DNR. The family members of these patients usually consent to DNR. Conclusions: Most surgical critical patients have not had time to discuss DNR with their families, and thus decision-making is difficult for these family members who have to act as the patients' surrogates. Thus, advocating a positive attitude towards DNR among the public and urging the public to discuss with their families about their own dying wishes before they reach a terminal stage in disease become very important.

並列關鍵字

Do Not Resuscitation(DNR) ； Cardiac Pulmonary Resuscitation(CPR) ； Intensive unit care (ICU) ； terminal patient ； Medical decision making

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