影響醫護人員推動病人自主權利法意願之相關因素探討

病人自主權利法於2019年施行，是為尊重病人醫療自主、保障善終權益及促進醫病關係和諧而制定。在個人意識及法規政策下產生的預立醫療指示不只是醫療自主，也具有法律效用，故醫護人員在醫療專業領域的控制權與主導權將面臨重新分配與不可避開的挑戰。本研究目的在探討影響醫護人員推動病人自主權利法意願之相關因素，採橫斷式研究設計，於中部某醫學中心，立意取樣，於2022年5月至6月對282位醫護人員進行資料收集。納入條件為具有合格證書且通過試用期之醫護人員，排除門診、手術室、檢查室、病理科、放射科之醫護人員。研究工具含社會人口學特性、病人自主權利法知識與預立醫療指示的推動意願之問卷。資料以SPSS22.0套裝軟體進行個人特質、病人自主權利法認知及推動意願之相關因素分析。結果共收案醫護人員281人，發現醫護人員在病人自主權利法知識方面平均得分 67.26；預立醫療指示推動意願整體平均得分4.44。經濟及簽署過DNR為病人自主權利法認知的影響因素；主管、經濟及簽署過DNR為預立醫療指示推動意願的影響因素。經濟 (p<0.001)為顯著預測因子。建議未來可繼續探討經濟狀況、預立醫療指示的諮商收費或其他相關因素在病人自主權利法推動的影響，提供政策研擬或修正之參考，或能提升諮商率及推動預立醫療指示簽屬率，方能得以實現善終理想。

關鍵字

病人自主權利法；認知；預立醫療指示推動意願

並列摘要

The Patient Right to Autonomy Act has been enforced since 2019. The aim was to respect patient autonomy, protect rights to a good death, and promote peaceful relations between caregivers and patients. Advanced directives either by the patients’ will or by law not only serve as medical autonomy, but also have legal utility. Thus, the control and dominance of medical staff in the field of medical profession faces redistribution and unavoidable challenges. The purpose of this study is to explore factors that affect the willingness of medical staff to promote the patient right to autonomy act. In this cross-sectional study, we use purposive sampling and collected data from 282 medical staff of a medical center in central Taiwan from May to June 2022. We included certified medical personnel who have passed the probationary period and excluded staff serving at outpatient departments, operating rooms, examination rooms, pathology departments, and radiology departments. Research tools included questionnaires on sociodemographic characteristics, knowledge of the patient autonomy act and willingness to promote advance directives. Data was analyzed using SPSS 22.0. From 281 effective samples, we found that the mean score of knowledge of the patient autonomy act was 67.26, and the average willingness to promote advance directives was 4.44. Factors that correlated with the persons’ knowledge of the patient autonomy act were their economic status and whether they have previously signed DNRs. Whereas the willingness to promote advance directives was affected by supervisors, economic status, and having previously signed DNRs. Economic status was a significant predictor (p < 0.001). We suggest future studies to further explore the relationship between economic status, consultation fees of advance directives and other factors that may affect the promotion of the patient autonomy act to provide guidance for future policies, increase consultation rates, signature rates of advance directives to better achieve the goal of providing the option of good death.