老人的醫療自主性意願及其相關影響因素探討

Study of the Elderly Taiwanese Patient’s Medical Autonomy and the Relating Factors

王詩盈(Shin-Ying Wang)

指導教授 ： 戴玉慈

國立臺灣大學/醫學院/護理學研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.03080

摘要

尊重病人自主，係指有能力作決定的病人（competent patient）應享有權利，如決定及選擇自己期望的照顧方式，這是醫學倫理首要之原則。台灣自邁入老年國以來，老年族群日益龐大。隨著老化，個人罹病的機率增加也可能面對無可避免的生理衰退及功能受限，關於治療疾病的相關訊息及決策也隨之增加，但其意願卻常常被忽略；然而了解其意願及感受，方能提供適切的服務以滿足其需求。因此，本研究的目的在探討老人的醫療自主性意願（尋求醫療資訊、參與醫療決策）及其相關影響因素，採橫斷式相關性研究設計，以自主偏好指數（Autonomy Preference Index）為測量老人醫療自主性意願的工具，於2009年8月至2009年10月止，以立意取樣及面對面訪談的方式於台北市某醫學中心進行收案，有效樣本共98人。將所收集資料，以SPSS15.0版進行統計分析。
研究結果發現：（1）老人參與醫療決策自主偏好，於老人-醫師組合中自主偏好平均分為2.55分±0.52，傾向將決策權交由醫師或與醫師共同參與醫療決策；於老人-家屬組合，平均分為3.64分±0.69，偏好與家屬共同參與醫療決策或將醫療決策權由自己掌控。（2）老人對於尋求醫療訊息有高度偏好，平均得分為4.40分±0.68。（3）疾病嚴重度高時，老人參與醫療決策自主偏好程度低。（4）尋求醫療資訊偏好與參與醫療決策自主偏好呈正相關。（5）老人對於醫師的決策期待，最高之前二項為「分析決策利弊」及「提供有關決策的詳細資訊」，對於家屬的決策期待，最高之前二項為「陪伴」及「配合醫師的建議」。（6）老人參與醫療決策自主偏好在老人-醫師組合之重要預測因子為教育程度 / 沒有上學、教育程度 / 高中（職）、年齡 / 76-80歲，可解釋的變異量為13.68 %（p＜.001），老人參與醫療決策自主偏好在老人-家屬組合之重要預測因子為性別 / 男性、教育程度 / 沒有上學、年齡 / 76-80歲、經濟來源 / 非由子女供應、居住型態 / 獨居，可解釋的變異量為41 %（p＜.001）。老人尋求醫療資訊偏好之重要預測因子為經濟來源 / 非由子女供應、教育程度 / 沒有上學、居住型態 / 獨居，可解釋的變異量為24.7%（p＜.001）。
本研究發現，提供適合且可理解的醫療資訊有助老人主動參與醫療決策，作者建議醫護人員應於照護過程中了解老人的特性及意願，協助老人瞭解資訊及鼓勵表達意願，促進醫療人員、老人、家屬之間之有效溝通，以維護老人的醫療自主權。

關鍵字

老人 ； 醫療自主性 ； 參與醫療決策 ； 尋求醫療資訊

並列摘要

Respect for patient autonomy is a primary principle of bioethics and means the right of competent patients to determine their own health issues. With the rapid aging of the Taiwan population, an ever increasing number of elderly confront morbidity and physical decline and limited physical function. Although the demand for relevant information to make informed decisions about treatments is increasing, the preferences and needs of the elderly are often neglected. Understanding the preferences and perceptions of the elderly is the basis for providing appropriate and satisfactory care. The aim of this study, therefore, was to investigate the preferences for autonomy in seeking medical information, participation in medical decision-making and related factors in the elderly population of Taiwan. A cross-sectional study was designed and 98 cases were collected in a medical center in northern Taiwan from August 2009 to October 2009. This study was conducted by purposive sampling and face-to-face interview using the Autonomy Preference Index (API) to measure elderly medical autonomy. Data was analyzed using SPSS software version 15.0.
The results showed that: (1) elderly participation in medical decision-making autonomy preferences of the “elderly - doctor combination” (mean score 2.55 ± 0.52), which means that the elderly tend to collaborate or give the decision to a physician; and the “elderly - family combination” (mean score was 3.64 ± 0.69), which means the elderly prefer to make decisions in collaboration with family or make decision by their own; (2) the elderly have a high intention to seek medical information (mean score 4.40 ± 0.68); (3) the elderly prefer a greater degree of autonomy when faced with making a medical decision about a more serious disease; (4) there is a positive correlation between the preference for information seeking and preference for medical decision-making; (5) among the expectations of the elderly when make a decision, the top two items that elderly expected from a physician were “analysis of the pros and cons” and “ provide detailed information”, and the top two items that the elderly expected family were “accompanying” and “following the recommendation of the physician”; (6) uneducated, high school education, and being aged 76 to 80 years old were predictors of the elderly participation in medical decision – making autonomy preferences for the elderly - doctor combination, the explainable variance is 13.68% (P < .001). Being male, uneducated, aged 76 to 80 years old, not being supported by children, and living alone were predictors of elderly participation in medical decision-making autonomy preferences for the elderly – family combination, the explainable variance is 41% (P < .001). Not being supported by children, uneducated and living alone were predictors of the elderly seeking medical information preferences, the explainable variance is 24.7% (P < .001).
According to these results, providing appropriate and comprehensible medical information may increase the willingness of elder people to participate in the medical decision making. Moreover, in order to improve the communication between medical staff, the elderly and family members, and maintain the decision-making right of elderly, medical staff need to understand the characteristics and willingness of elderly patients and assist them in obtaining medical information or self-expression.

並列關鍵字

elderly ； medical autonomy ； seeking medical information ； participation in medical decision-making

參考文獻

安寧緩和醫療條例（2002年12月11日修正）•華總一義字第09100239020號令。

呂寶靜（1999）•老人使用日間照護服務的決定過程：誰的需求？誰的決定？•台大社會工作學刊，1，181-229。

李明濱（1997）•病人自主與知情同意•醫學教育，1（4），377-387。

吳佳穎、蔡甫昌、陳慶餘（2003）•病情告知•當代醫學，31（11），875-878。

吳宜芳（2001）•探討加護病房家屬對疾病末期病人醫療決策行為意向及其影響因素•未發表的碩士論文，臺灣大學護理學研究所。