醫師對安寧緩和病人接受新冠狀病毒疫苗的共識調查：南部某醫學中心經驗

Consensus among Physicians towards Covid-19 Vaccination for Hospice and Palliative Patients: A study at a Medical Center in Southern Taiwan

陳朝棟(Chou-Tung Chen) ； 黃偉城(Wei-Cheng Huang) ； 陳潔宜(Chieh-I Chen) ； 黃琨祥(Kun-Siang Huang) ； 陳暉明(Hui-Ming Chen) ； 王培銘(Pei-Ming Wang) ； 林宏昇(Hung-Sheng Lin) ； 陳偉熹(Wei-Hsi Chen)

《安寧療護雜誌》 26卷3期 (2022/11) Pp. 205-223

https://doi.org/10.6537/TJHPC.202211_26(3).01

摘要

研究目的：接種新冠狀病毒疫苗是目前減少嚴重特殊傳染性肺炎發生和死亡的方法之一。雖然研究證實慢性病病人被感染和感染後死亡的機率較一般人為高，專家也呼籲慢性病人接受疫苗接種之重要性，卻沒有關於醫療人員對安寧緩和病人接種疫苗之意見調查，可能因此忽視了安寧緩和病人的接種意願和權益。研究方法：本研究由作者群自行設計不同安寧緩和的虛擬情境，從準備預立安寧緩和醫療暨維生之意願至生命末期，病人分別處在意識清楚或意識不清楚之狀況，由病人本人或家屬提出疫苗接種的要求，調查醫師對病人接種疫苗的看法和疫苗廠牌的偏好。本研究的參加者是在臺灣南部某醫學中心服務，必須接受符合規定的安寧緩和訓練。研究結果：分析顯示醫師對安寧緩和病人接受疫苗接種，大多持正向和支持的看法。重要影響因素有安寧緩和預後程度、臨床適合度、自主表現和疫苗傷害。另外，在整體上醫師對疫苗廠牌沒有特殊偏好。結論：建議政府和學會應該盡快建立關於疫苗接種之醫療照顧和教育的準則，保障安寧緩和病人權益。

關鍵字

嚴重特殊傳染性肺炎 ； 新冠狀病毒疫苗 ； 安寧緩和 ； 自主 ； 疫苗猶疑

並列摘要

Purpose: Vaccination is an effective method to reduce the occurrence and mortality of the Coronavirus Disease 2019 (COVID-19) pandemic. Overwhelming studies have revealed the frequency of COVID-19 infections and post-infectious mortality to be higher in persons with chronic diseases than without them. In addition, specialists also call civilians to receive full vaccination. However, there is a shortage of information concerning the vaccination in patients receiving hospice and palliative care. A wrong message may let patients receiving hospice and palliative care to lose their opportunity and protection for vaccination. Method: In this study, authors designed different scenarios ranging from preparing to complete the letter of intent for the choice for hospice palliative care and life-sustaining treatment to end-of-life hospice care. The virtual patients were conscious or unconscious, and either virtual patients or their family requested vaccination. The aim of this study was to investigate the attitude of physicians for vaccination and selection of label in patients receiving hospice and palliative care. Participants were from a single medical center at south Taiwan and had received standard hospice/palliative training. Result: Results showed that most of the physicians expressed a positive and supportive attitude for vaccination in patients receiving hospice and palliative care. The influential factors included the severity of hospice/palliation level, the suitability of clinical conditions, autonomous performance and vaccine harm. Moreover, physicians did not show preference for any label. Conclusion: We suggest government and medical association to setup the principles of medical care and education for COVID-19 vaccination in order to protect the right of patients receiving hospice and palliative care.

並列關鍵字

Coronavirus Disease 2019 ； new coronavirus vaccine ； hospice and palliation ； autonomy ； vaccine hesitancy

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