某醫院生命末期病患接受家庭會議、安寧緩和照護與簽署不施行心肺復甦術之回溯性研究

A retrospective study of end-of-life patients who had received family conference, palliative care, and DNR signature in a Hospital

張文演(Wen-Yen Chang) ； 張淑美(Sue-May Chang)

《安寧療護雜誌》 26卷3期 (2022/11) Pp. 224-238

https://doi.org/10.6537/TJHPC.202211_26(3).02

摘要

研究目的：善終是每個生命末期患者的主要目標，而家庭會議是解決末期醫療決策的好方式，但臨床與過去的研究顯示家庭會議與安寧緩和照護服務使用率並不高，本研究欲瞭解生命末期病患接受家庭會議、安寧緩和照護與簽署DNR之現況並分析相關影響因素。研究方法：採用病歷回溯性研究，蒐集某區域教學醫院2019年1月1日至2019年12月31日住院後死亡之病歷資料共519份，以SPSS軟體做描述性統計與卡方檢定。結果：死亡病患以男性、85歲以上老人、非癌症診斷及入院3天內死亡之急重症為最多。末期病患接受家庭會議比率為36.4%，安寧緩和照護率為22.5%，DNR簽署率為94%。結論：家庭會議對生命末期病患接受安寧緩和照護有明顯幫助；癌症診斷與家庭會議、安寧緩和照護及簽署DNR都有顯著性差異；宗教信仰與安寧緩和照護有顯著性差異；住院15天以上對家庭會議與安寧緩和照護顯著性皆高於0-3天。癌症末期病患於死亡前有較高的家庭會議與安寧緩和照護率，非癌症末期病患死亡前接受家庭會議與安寧緩和照護仍偏低，而家庭會議在末期醫療決策至為重要，且愈早召開家庭會議，病患愈能盡早接受安寧緩和照護，家屬也愈有充足的時間做死亡準備。

關鍵字

家庭會議 ； 安寧緩和照護 ； 不施行心肺復甦術

並列摘要

Purpose: Palliative care is the best way of achieving a good death for end-of-life patients, and family conference is an ideal method for medical decision making. Nevertheless, according to the previous research and clinical experience, palliative care and family conference is not common. This study aims to analyze the influencing factors and the current situations of the palliative care, family conference, and the DNR signature (Do not Resuscitate, DNR). Method: We conducted a retrospective study analyzing 519 cases of Death Medical Records, hospitalized date from 1 January 2019 to 31 December 2019. Statistical methods used Pearson's Chi-Squared Test and SPSS 24 version software. Result: The highest death rate included the following variables: male, over 85 years old, non-cancer patient, and die-within-3-days hospitalization. The terminally ill patients who had received family conference, palliative care and DNR signature is 36.4%, 22.5%, and 94% respectively. Conclusion: Family conference are helpful for terminally ill patients to receive palliative care. The cancer diagnosis has a significant impact on the family conference, palliative care, and DNR signature. Patient religions have a significant correlation with palliative care. Hospitalization over 15 days has an important influence on both family conference and palliative care, comparing to hospitalization less than 3 days. Cancer patients have a higher ratio of conducting family conference and palliative care whereas the non-cancer patients do not. Family conference are very important in the end-of-life medical decision making. The sooner the family conference is held, the sooner patients can receive palliative care and the family members will have more time to prepare for death.

並列關鍵字

terminal stage ； DNR ； palliative care ； family conference

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