生命末期病人在安寧緩和療護之健康需求評估

The Health-need Assessment of End-of-Life Patient in Hospice and Palliative Care

徐玉娟(Yu-Jiuan Hsu)

指導教授 ： 張玨

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2017年)

https://doi.org/10.6342/NTU201704167

摘要

背景：衛生福利部統計處統計資料顯示，依死亡率排序，癌症為台灣十大死因之首，其瀕死階段是屬於高成本的健康照護，而安寧療護確實有達到節省成本支出的成效，但台灣癌症病人使用安寧療護之比率較國外為低且集中於醫學中心，然而早期緩和醫療可以減少不必要的住院治療和醫療服務。因此深入瞭解生命末期病人之安寧療護健康及健康資源需求確實有其急迫性。
目標：瞭解生命末期病人健康需求的多元樣態，以作為未來發展相關衛生與福利方案之參考。
方法：本研究為質性研究，以詮釋現象學做為研究的方法論，其訪談資料之分析方法採用 Huberman 與 Miles (1994)所提出質性資料分析的步驟，以Bradshow (1972)提出的四種需求來進行需求評估，並以檔案分析法來收集呈現需求與比較需求之資料，以深入訪談法收集專家需求與感覺需求之資料。訪談資料的收集期間為2017年01月至2017年07月，研究對象病人2位、主要照顧者2位、醫師2位、護理師5位，共11位。
結果：在感覺與專家需求方面發現，生命末期病人在生理面有「症狀控制」需求；心理面的「心理調適」需求；社會面的「家人支持與陪伴」、「與其他癌症病友互動」、「即時之專業醫療諮詢」、「喘息服務」等需求。在呈現需求方面，截至106年7月14日目前已有66家醫院提供安寧病房服務，104家醫療機構提供安寧居家服務，與147家醫院提供病房安寧共照服務，237家院所提供社區安寧服務。癌症依據健保署2011至2014年癌症安寧人數及衛生福利部死因統計之癌症死亡人數計算，各年度分別為45.2%、63.1%、73.4%及82.1%，呈現歷年增幅遞減現象，平均年遞減率為29%，依遞減率推估2015年（含）之後歷年照護率，以100%為上限。在比較需求方面顯示，對於生命末期病人的健康需求，病人、主要照顧者與專家的觀點有些不同，且有許多生命末期病人的健康需求未被滿足。
結論：生命末期病人之健康需求相當廣泛，且尚有許多健康需求未被滿足，在未來相關政策的規劃上，應重視這些健康需求，並廣納各方意見。
關鍵字：生命末期、安寧緩和療護、健康需求、需求評估、心理健康

關鍵字

生命末期 ； 安寧緩和療護 ； 健康需求 ； 需求評估 ； 心理健康

並列摘要

Background:
According to the statistic from Ministry of Health and Welfare, on the basis of the order of death rate, cancer has been the top factor to cause death. in the nearing death stage, it belongs the high-cost health care, while hospice and palliative care has approach effects on saving cost. However, the rate on using hospice and palliative care for cancer patients is lower than those in other countries and most of patients choose to go to medical center. Nevertheless, early-aged hospice and palliative care can decrease the unnecessary service on treatment and medical care. Therefore, deep understanding hospice and palliative care and health-need resource for end-of-life patients is in urgent.
Object:
To understand the diversity of health-need for end-of-life patients, this thesis can be the reference for the related development of Health and Welfare project.
Method:
The method in this thesis is qualitative research. The researcher uses hermeneutic phenomenology as research way. For the interview resource, the researcher applies the process of analysing qualitative resource, proposed by Huberman and Miles (1994), and on the basis of four needs, submitted by Bradshow (1972) to conduct need assessment; furthermore, the researcher uses data analysis to collect the data between presented needs and comparative needs. Last, the researcher applies deep interview method to gather data between expert needs and felt needs. The day of collecting data is from January to July, 2017. The research objects are two patients, main caregivers, doctors, and five registered nurses. There are totally eleven objects.
Result:
In the founding of felt and expert needs, in physical facet, the end-of-life patients have “symtom control” needs, in mental facet, they have “mental accommodation” needs, in social facet, they have “family support and company,” “the interaction with other cancer patients,” “immediately professional medical information,” “respite care service,” etc. In the presented facet, up to July 14th, 2017, there are already sixty-six hospitals which provide hospice and palliative care service, one hundred and four family medical centers have provided palliative medicine in the home service, one hundred and forty seven hospitals have provided hospice palliative shared care service, and two hundred and thirty seven hospitals have provided community hospice palliative care service. According to the statistic in the caculation of dead body by National Health Insurance Administration, and Ministry of Health and Welfare, from 2011 to 2014. It can be summarized as follows, 45.2% in 2011, 63.1% in 2012, 73.4% in 2013, and 82.1% in 2014. The result shows that the percentage number has been raised year by year, and the average declining rate is 29%. On the basis of decling rate, the researcher estimates that the care rate after 2015 will get much higher, and the limited rate is 100%. In the comparative needs facet, it shows that in end-of-life patients’ health needs, there are some different points of view in patients, main caregivers, and experts; furthermore, there are a few end-of-life patients’ health needs are not satisfied.
Conclusion:
It is a wide range in end-of-life patients’ health needs, and there are a few health needs which has not been satisfied. For the related government policy plan in the future, we should attach importance to these health needs and accept opinions from different aspects.
Keywords: End-of-life, hospice palliative care, health needs, needs assessment,mental health

並列關鍵字

End-of-life ； hospice palliative care ； health needs ； needs assessment ； mental health

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