台灣長期人工呼吸器依賴慢性阻塞性肺病患者之主要照顧者對於安寧療護之看法

背景與目的: 末期病患的臨終照護，近來已在世界上顯的日趨重要。政府從民國84年開始主導安寧療護的政策，但在台灣，對於長期人工呼吸器依賴慢性阻塞性肺病病人何時接受安寧療護的決定權，都是操之於照顧者的手裡。過去人們的信念總以為要盡量幫病人延命，然而更重要的是去了解長期人工呼吸器依賴慢性阻塞性肺病病人其主要照顧者對於安寧療護的看法，以改善病人的生活品質。對象與方法: 利用訪談指引，我們採一對一的訪談，並使用內容分析法來探討接受安寧療護的看法。結果:共訪談四位主要照顧者。就算病人沒有生活品質，他們都要維持其家人的生命跡象，直到血流動力學變差的情形下，才肯接受安寧療護。然而，若是他們也罹患慢性阻塞性肺病，當呼吸衰竭須插管時，他們都會拒絕插管。結論: 主要照顧者要維持其家人的生命跡象，直到血流動力學變差的情形下，才肯接受安寧療護。但若是主要照顧者也罹患慢性阻塞性肺病，當呼吸衰竭需被插入氣管內管時，他們會拒絕這種延命治療，而選擇安寧療護。

關鍵字

慢性阻塞性肺病；長期人工呼吸器依賴；安寧療護；呼吸衰竭；臨終

並列摘要

Background and Purpose: Terminal care for patients with different diseases of end-stage becomes more and more important all over the world. Since 1995, the government had guided the policy of hospice care , but most of the decision making about when the prolonged mechanical ventilator chronic obstructive pulmonary disease (COPD) patients to receive hospice care has been decided by the main caregivers in Taiwan. To prolong life for the patient was a belief in the past. However, it is much more important to understand the viewpoints for these patients to receive hospice care to increase their quality of life. Patients and method: Using interview guide, we will interview each caregiver. We use content analysis to explore the viewpoints of receiving hospice care of the main caregivers. Results: Total 4 main caregivers had been interviewed. All of them want to maintain their families’ life rather than receiving hospice care even in poor quality of life until hemodynamics got downhill. However, all of them refuse endotracheal tube intubation when respiratory failure happened if they got COPD. Conclusion: Main caregivers want to maintain their families’ life and would accept hospice care until hemodynamics got downhill. However, they refuse these life-prolonging treatment if they got COPD with respiratory failure. Instead, they choose hospice care.

並列關鍵字

COPD ； prolonged mechanical ventilator dependent ； hospice care ； respiratory failure ； end of life

參考文獻

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台灣長期人工呼吸器依賴慢性阻塞性肺病患者之主要照顧者對於安寧療護之看法

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