預立醫療照護計畫於晚期慢性病個案及其照顧者之成效：系統性文獻回顧

背景：慢性病個案往往面臨多元不適症狀及避免無效醫療之抉擇；而華人社會討論末期疾病照護抉擇是忌諱議題，故對醫療團隊而言，讓個案及其照顧者經由「預立醫療照護計畫（Advance Care Planning, ACP）」以減少面對生命末期醫療決策壓力，是臨終照護重要議題。目的：透過系統文獻回顧，探討晚期慢性病個案及其照顧者接受ACP介入後成效。方法：搜尋2000年01月至2019年12月PubMed、The Cochrane Library和華藝線上圖書館中有介入ACP的隨機分派臨床試驗研究。結果：共5篇文章，1,309位個案及其照顧者，發現經由培訓護理師提供ACP介入處置，可減少個案醫療決策衝突、提高溝通品質及達到醫療偏好一致性，也可減少照顧者焦慮、憂鬱和創傷後症狀群。然而，ACP介入不一致的成效有隨時間而改變偏好、未接受緩和治療詢問預後和臨終問題時會感到驚訝、受當地政策及背景影響，使個案不願表達意願。討論／臨床應用：經訓練過護理師，透過視頻決策工具和跨領域照護模式推動，以提升照護團隊ACP知識及技巧及共同訂定照護目標，以滿足生命末期醫療決策上照護需求，進而提高臨終照護品質。

關鍵字

預立醫療照護計畫；晚期慢性病個案；照顧者

並列摘要

Background: Patients with chronic diseases at their end-of-life (EOL) stage will encounter multifaceted physical problems and choices of treatments to avoid medical futility. It has been taboo to discuss EOL care issues in Chinese culture; therefore, how to achieve a quality of death appears to be a challenge for healthcare providers. The engagement of patients and their caregivers in advance care planning (ACP) to reduce their stress in EOF decision-making is an important issue for hospice and palliative care. Purpose: A systematic review of the literature to examine the effectiveness of ACP in patients with end-stage chronic diseases and their caregivers. Methods: The authors searched interventional studies on examining the effectiveness of ACP published between January 2000 and December 2019 from related database including PubMed, The Cochrane Library, and the National Library Journal Information Network. Results: Five randomized controlled trials with a total of 1309 end-stage chronic diseases and their caregivers (an average age of 64.4 to 86.7 years) were included in this review. The results from this review indicated that the provision of ACP via trained nurses could reduce the patients' medical decision-making conflicts, quality of communication, and consistent medical care preference; and reduce caregivers' anxiety, depression and post-traumatic stress disorder. However, the inconsistent results included changed patients' nursing care preferences, surprised feelings when asked about prognosis and EOL issues for patients without receiving palliative care, and not willing to express their EOL options due to the local health care policy and cultural context. Conclusions/ Implications for Practice: Well-trained nurses provided end-stage patients and their caregivers with ACP via video on decision-making tool and interdisciplinary team approach improved the knowledge and skills about ACP and concordance of medical care with patients' preferences for healthcare team to meet their EOL decision-making care needs, enhancing the quality of EOL care for these patients.

並列關鍵字

advance care planning ； patients with chronic illness at end stage ； caregiver

參考文獻

謝至鎠、王淑貞、王英偉（2013）．符合社區民眾預立醫療自主計劃文化觀點之介入模式－台灣花蓮地區之經驗．安寧療護雜誌，18（1），1-13。doi:10.6537/TJHPC.2013.18(1).1

蘇思憓、吳麗敏（2018）．重症病患決策代理人之醫療決策行為意向及其相關因素探討．護理雜誌，65（2），32-42。doi:10.6224/JN.201804_65(2).06

Aw, D., Hayhoe, B., Smajdor, A., Bowker, L. K., Conroy, S. P., & Myint, P. K. (2012). Advance care planning and the older patient. QJM, 105(3), 225-230. doi:10.1093/qjmed/hcr209

Billings, J. A., & Bernacki, R. (2014). Strategic targeting of advance care planning interventions: The Goldilocks phenomenon. JAMA Internal Medicine, 174(4), 620-624. doi:10.1001/jamainternmed.2013.14384

Chan, H. Y. L., Ng, J. S. C., Chan, K. S., Ko, P. S., Leung, D. Y. P., Chan, C. W. H., ... Lee, D. T. F. (2018). Effects of a nurse-led post-discharge advance care planning programme for community-dwelling patients nearing the end of life and their family members: A randomised controlled trial. International Journal of Nursing Studies, 87, 26-33. doi:10.1016/j.ijnurstu.2018.07.008

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預立醫療照護計畫於晚期慢性病個案及其照顧者之成效：系統性文獻回顧

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