醫護人員撤除生命末期病人維生治療行為意向之影響因素

The Associated Factors about Behavior Intentions of the Medical Personnel to Withdraw Life Support Treatment with Patients at End of Life

張瓊尹(Chiung-Yin Chang)

指導教授 ： 胡文郁

國立臺灣大學/醫學院/護理學研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.02216

摘要

本研究旨在了解重症單位醫護人員對於撤除微升至療之認知態度與行為及其影響因素。以橫斷式描述研究，採立意取樣，使用結構式問卷進行資料收集，研究對象以臺灣北部某醫學中心急重症單位醫護人員為研究對象，醫師與護理人員共收案262名個案，醫師90名，護理人員172名。研究工具為自擬問卷，經專家效度，及表面信度修改後，以探索性因素分析進行建構效度測試。問卷內容包括「基本屬性調查表」、「撤除維生治療認知量表」、「撤除維生治療態度感受量表」、「撤除維生治療的影響因素調查表」與「撤除維生治療行為意向調查表」五部分。所得資料以描述性統計呈現基本屬性及各變項，並以單因子變異數分析、皮爾森積差相關及逐步迴歸分析，找出急重症單位醫護人員對於執行撤除維生治療行為意向之重要相關影響因素。研究結果發現：1) 醫師在撤除維生治療認知量表之正確率 (74.6%)較護理師(67.9%)高。2)醫護人員均對撤除維生治療態度趨於正向，護理師對於撤除維生治療好處的感受相較於威脅性及壞處感受得分較高。3)對急症生命末期情境之撤除維生治療行為意向得分，較慢性末期情境高，即傾向撤除。4)對安寧條例與撤除維生治療之接受度、近期有親友末期經驗者、好處感受高或壞處感受少，均為影響醫護人員撤除維生治療行為意向的重要預測因子，總解釋變異量達28%。
本研究建議醫護人員應先建立生命末期之共識，加強生命教育，提升對安寧條例與撤除維生治療之認知與接受度，以減少醫療團隊及病患家屬陷入倫理困境，並在撤除維生治療執行的態度與行為意向方面，建立本土化資料，提供未來照護之參考依據，讓醫護人員提供優質之急重症生命末期病患照護。

關鍵字

撤除維生治療 ； 行為意向 ； 緩和醫療 ； 生命末期 ； 態度

並列摘要

Although the idea of palliative care was widely recognized and accepted, the restrictions of regulations and laws made the medical staff face the ethical and legal predicaments caused by futile medical care. The aim of the study was to understand the medical staff’s intentions toward withdrawing life supporting systems, factors impeding the execution of withdrawing life supporting treatment and related factors affecting the withdrawal of life supporting systems in divisions of critical care and to provide the references for medical staff in charge of critical care. The study was cross-sectional study with purpose sampling, collecting data with structured questionnaires and establishing localized data by focusing the attitudes, behavioral intentions and related factors about the withdrawal of life supporting systems. The study subjects were recruited from a medical centers in northern Taiwan, including nurses and physicians. The data were further analyzed by descriptive statistics for “demographic characteristics”, and “independent-sample t-test”, “one way ANOVA”, “Pearson's product-moment correlation coefficient” and “multiple regression analysis” for other factors associated about the knowledge, attitude and Intention behavior in withdrawing life supporting treatment. We hope to understand the medical staff’s intentions toward withdrawing life supporting systems, factors impeding the execution of withdrawing life supporting systems and related factors affecting the withdrawal of life supporting systems in divisions of critical care and to provide the references for medical staff in charge of critical care through the study and to decrease the risk of facing the dilemmas for both medical staff and patients’relatives. The results of this study revealed that there is higher percentage of correct answering the question about the withdrawing of life support system in physicians group (74.6%), while compairing to the nurse group(67.9%). The attitude of life support system withdrawing had positive relationship in both group and the objective positive feedback for the life support system withdrawing is stronger in the nurse group. While considering the disease factor for the decision-making tendency in life support system withdrawing, withdraw for a patient in acute end of life issue had more tendency than chronic one. Other important factos affecting the decision making of life support system withdrawing in medical staff includes: the acceptability of Hospice Palliative Care Regulation, the recent personal experience in dealing with the issue of end of life, better objective positive feedback, or poor objective positive feedback. The over all Total Variance Explained after adjustement was 28%.
The study discovered that by means of redefined defenition of end of life, augmented life education, thoroughly understood of Hospice Palliative Care Regulation in the medical staff, the ethical conflicts of life support system withdrawing which bothered the medical staff and patient’s relatives would be softened. We are looking for the localizaed data base about the medical staff attitude and factors affecting the decision making process in such situiation. Finally, we hope to offer a reference for clinicians to make a proper decision while being caught in a dilemma.

並列關鍵字

Withdrawal of life supporting treatment ； Intention Behavior ； palliative care ； End of life ； Attititude

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