探討老年與非老年癌末病患死亡前最後一次住院醫療利用情形

Study of Medical Utilization of Older and Younger Cancer Patients at Terminal Stage

溫純芳(Chun-Fang Wen) ； 蔡江欽(Chiang-Chin Tsai)

《南臺灣醫學雜誌》 13卷1期 (2017/06) Pp. 14-19

https://doi.org/10.6726/MJST.201706_13(1).0002

摘要

目的：主要探討不同年齡癌症病患不施行心肺復甦術(Do Not Resuscitate, DNR)簽署時點與死亡前一次住院醫療利用情形。。方法：以南部某一區域教學醫院癌症登記資料庫死亡案例共473例為研究對象。藉由病歷回溯(Chart Review)資料蒐集其DNR簽署與醫療利用情形，利用統計軟體SPSS 18.0進行統計分析。結果:不同年齡人口學特性以婚姻狀況、教育程度、癌症別與簽署文件達顯著意義(P ＜ 0.05)，經以羅吉斯迴歸統計，在控制相關變項下，老年人和非老年人醫療利用中鎮靜安眠藥藥物與簽署文件達顯著意義(P ＜ 0.05)。結論：本研究結果發現DNR早期簽署佔63.2 % ，年齡並未影響簽署情形，顯示本國安寧緩和條例立法10餘年，其臨終照護品質上似有長足的進步。簽署情況也以家屬簽署佔多數，建議臨床照護上當病情有階段性改變時，醫師與醫療團隊應提早與病人、家屬做病情告知與共享醫病決策，讓病人參與選擇醫療照護，以提升末期照護的品質。

關鍵字

生命末期 ； 簽署時點 ； DNR ； 醫療利用 ； 老年人

並列摘要

Objective: To investigate the relationship between the timing of signature of DNR(Do Not Resuscitate) order of cancer patients in different ages and the utilization of medical resources during the period between their last admission. Methods: Based on a registered data bank of the deceased cancer patients in a teaching hospital in southern Taiwan, totally 473 cases are studied. A statistical analysis is conducted via the statistics software SPSS 18.0, after using Chart Review to collect the data of DNR signature and the related utilization of medical resources. Results: Some demo graphical characteristics, like marriage status, educational degree, and particular cancer type, have reached a significant (p＜0.05) across different ages in DNR signature. In a statistics of logistic regression, when some related variables are under control, the medical utilization of sedatives among the elderly or the non-elderly also reaches a significant reading (p＜0.05) in DNR signature. Conclusions: This study finds that an early signature of DNR reaches 63.2% of those studied cases and the factor of age does not affect the signature of DNR. This means, after Taiwan's legislation of the Hospice Palliative Care Act over a decade, that the quality of hospice medical have made a great advance. As the DNR signature is mostly signed by the families of those cancer patients, this study suggests physicians and their medical teams should proceed a shared decision making: i.e. informing the patients and their families about the status of the cancer development as early as possible, once the health of cancer patient at clinical bed is turned into a critical phase. In order to upgrade the quality of hospice medical service, it is a positive direction to inform the situations to the cancer patients at their end-of-life and invite them to make the shared decision among optional hospice medical.

並列關鍵字

medical utilization ； end-of life ； DNR ； elderly