影響中高齡者簽署預立醫療決定書之相關因素研究

Factors Associated with Middle-aged and Older Adults Signing the Advance Decision Consent

張慧美(Chang, H.-M.) ； 林清壽(Lin, C.-S.)

《福祉科技與服務管理學刊》 9卷2期 (2021/06) Pp. 123-139

https://doi.org/10.6283/JOCSG.202106_9(2).123

摘要

108年《病人自主權利法》實施後，民眾可以依照自主決定權，透過預立醫療照護諮商，提早預立意願書，決定當自己遭遇特定疾病狀況時，能夠依據自己真實意願，享有知情、選擇、決定如何走向生命終點的權利，達到有尊嚴的善終意願。本研究以南投縣45歲以上中高齡者為研究對象，以計畫行為理論為架構，透過網路問卷調查方法來探討影響中高齡者簽署預立醫療決定書之行為意向因素。研究結果發現，中高齡者對於簽署預立醫療決定書的「態度」、「主觀規範」、「知覺行為控制」與「行為意向」皆持正向同意。在不同受測者背景變項對簽署預立醫療決定書在「知覺行為控制」的認同差異分析方面，顯示年齡層愈低認同程度愈高；女性在「態度」、「知覺行為控制」與「行為意向」認同度明顯優於男性；教育程度越高對各構面的認同度越高；有聽過預立醫療決定書相關訊息的民眾在各構面的認同度皆高於沒有聽過的。此外，依據多元迴歸分析結果顯示，影響中高齡者簽署預立醫療決定書的行為意向最高者為「態度」，其次為「知覺行為控制」；顯示中高齡者簽署預立醫療決定書的行為意向，受個人對預立醫療決定書的認同態度影響最大，中高齡者對預立醫療決定書的認同程度愈高，則接受簽署預立醫療決定書的意願越高，而個人自身對簽署預立醫療決定書感到難易程度的影響次之。

關鍵字

病人自主權利法 ； 預立醫療照護諮商 ； 計畫行為理論

並列摘要

Since the implementation of the ＂Patient Autonomous Rights Act＂ in 2019, as per one's discretion, public suffering from a specific disease will be able to know, choose and decide how to reach the end of life as per their real wish, through pre-determined medical-care consultations, and pre-determined letters of intent. The right to decide the end of life helps in a dignified death. This work focuses on middle-aged and older adults aged over 45 years and is based on the theory of planning behavior. A questionnaire survey method was used to explore the factors influencing behavioral intentions of middle-aged and older adults to arrive at an advanced medical decision. The narrative statistical analysis of various aspects of the middle-aged and older adults, the ＂behavioral attitude＂, ＂subjective norms＂, and ＂perceived behavior control＂ constructs have significant and positive effects on the behavioral intention to sign pre-determined medical decision. The difference analysis shows that middle-aged and older adults sign the pre-approval medical decision as per their ＂perceived behavior control＂. The lower the age, the higher is the degree of recognition. Women's recognition of ＂perceived behavior control＂ and ＂behavior intention＂ is significantly higher than that of men; the higher the level of education, the higher is the recognition of each aspect; the degree of recognition is higher among people who are familiar with the information related to pre-determined medical decision letter than those who have not heard of it. In addition, according to multiple regression analysis, the highest behavioral intention that influences the middle-aged and older adults to sign the advanced medical decision is their attitude, followed by perceptual behavior control. The behavior intention of the middle-aged and older adults to sign the pre-determined medical decision is most affected by the individual's attitude to such decisions. The more the middle-aged and older adults agree with the advanced medical decision, the higher is the willingness to sign the advanced medical decision. The individual's own difficulty in signing the pre-determined medical decision is the second-most important reason.

並列關鍵字

patient autonomy act ； advanced care planning ； theory of planned behavior