- 期刊
探討中部某醫學中心加護病房老年病人及家屬對預立醫療指示的認知情形
Exploring Understanding of Advance Directives among the Elderly ICU Residents and Their Families at a Medical Center in Central Taiwan
摘要
背景：高齡者接收相關醫療訊息量少，或自覺目前疾病嚴重程度不高，還未考慮到相關問題，或缺乏簽署管道，或無法先與家人討論後做出決定，最後由家人決定其醫療，所以「預立醫療指示」討論率不高。目的：探討加護病房老年病人及家屬對「預立醫療指示」相關內容的認知情形與差異性。方法：橫斷式、描述性研究，採方便取樣，於中部某醫學中心內科加護病房進行收案，研究對象為加護病房病人及家屬，收案數病人30人、家屬65人(含與病人配對之家屬30人，以及單純由家屬代替病人提供資訊者35人)，以面訪方式進行結構式問卷調查。結果：對於「預立醫療指示」的認知，包括「心肺復甦術」、「維生醫療」、「不施行心肺復甦術、不予維生醫療及簽署相關同意書」方面，病人及家屬的了解程度多為不了解。研究比較收案病人及兩組家屬之間的差異性，結果家屬組家屬相較之下認知程度高於病人及病人組家屬。預立醫療指示的認知程度與病人的婚姻、教育以及主要照顧者有關，家屬方面，家屬組家屬具顯著性差異，與教育、主要醫療決策者以及家屬是否已經幫病人簽署「不施行心肺復甦術同意書」有關。加護病房病人及家屬，在預立醫療指示的認知之間並無顯著性差異(t=1.44，p=.18)。結論：病人及家屬對於「預立醫療指示」相關內容，建議應加強預立醫療指示內容的宣導與教育，給予正確之認知與觀念，將預立醫療指示觀念落實於社會大眾。
並列摘要
Background: Many elderly people in Taiwan choose to leave the decision concerning advanced directives (ADs) to their family members due to various reasons, notably their relatively limited access to medical information, reluctance in making necessary arrangement caused by underestimation of the severity of their illnesses, lack of knowledge about where and how to sign the document, and inability to make the decision by themselves. As a result, issues concerning ADs have received far less attention and discussion than they deserve. Purpose: To investigate the understanding of advanced directive among elderly ICU patients and their families and to identify factors associated with their understanding. Methods: A cross-sectional and descriptive study with purposive sampling was conducted at the ICUs of a medical center in central Taiwan. Patients aged ≥55 years and admitted to the ICUs and their families were enrolled. A total of 30 patients and 65 family members were recruited. (30 pairs of patients and their family members and 35 unpaired family members) Results: The majority of participants appeared to have no clear understanding of advance directives. Compared to the 30 pairs of patients and their family members, the 35 unpaired family members revealed a significantly better understanding of ADs. Patients who were high school educated, married and relied on their spouses as main caregivers appeared to understand Ads better. Among the 35 unpaired family members, those who were high school educated, decision makers, and had the experience of signing the DNR consent for a family member demonstrated a better understanding of Ads. No significant difference in the degree of understanding was observed between patients themselves and their family members (t=1.44，p=.18). Conclusion: Most of the respondents were in need of better understanding ADs. More active promotion and education are needed to enhance the public's understanding of Ads.