影響主要決策者對呼吸器困難脫離病人氣切決策之相關因素探討

研究目的：氣切手術對醫療人員是常見、簡單的手術，但臨床上病人家屬卻很難做決定。本研究旨在探討影響主要決策者對困難脫離呼吸器病人氣切決策之相關因素，以了解其決策時之困境。研究方法：採橫斷性、描述性研究設計，以方便取樣，利用自擬結構性問卷，於103年08月20日至103年12月7日以南部某醫學中心及某區域醫院之加護病房及呼吸照護中心困難脫離呼吸器行氣切決策之主要決策者為對象，共收案40位。研究結果：病人年齡、意識狀況、經濟狀況及氣切意願與氣切決策呈顯著相關；足夠的家庭支持及對氣切的了解程度越高之決策情境，有助於主要決策者執行氣切決策。決策過程會經歷兩階段，第一階段由醫師建議氣切開始，經歷 (1)不知所措尋資訊、(2)逐步了解辨分明等過程；第二階段為辨別氣切資訊後做決策至決策後的期待，會經歷：(1)多方評量做決策；(2)未來發展待觀察。結論：醫療人員應提供完整的氣切及疾病相關訊息，與決策者充分討論關於病人意願、預後及後續照顧問題，並評估主要決策者之家庭支持系統是否足夠，將有利於決策的進行，使決策更貼近病人意願。

關鍵字

呼吸器困難脫離；氣切決策；主要決策者

並列摘要

Purpose: The decision to proceed with a tracheostomy, which is a common and simple surgery performed by medical professionals, is particularly difficult for patients and their family members. The purpose of this study was to explore the associated factors affecting the decision-making of primary decision-makers on tracheostomy for difficult-to-wean patients, attempting to gain understanding of the dilemmas in decision-making. Methods: This is a cross-sectional descriptive study with convenience sampling and self-designed structured questionnaires. From August 20 to December 7 in 2014, we collected data from 40 primary decision-makers who made decisions on tracheostomy for difficult-to-wean patients from ICUs and respiratory care centers of a medical center and a regional hospital located in southern Taiwan. Results: The patients’ age, consciousness, economic situation, and willingness to receive tracheostomy were significantly correlated with decision-making on tracheostomy. Sufficient family support and higher knowledge level about tracheostomy assisted decision-makers in making decisions. The decision -making process included two stages. The first stage started with physician’s suggestion of a tracheotomy; the decision-makers would go through the following processes: (1) feeling bewildered and searching for information and (2) gradually understanding and distinguishing right from wrong. The second stage involved the period from making decisions after distinguishing searched information through the expectations following making decisions; the decision-makers would go through the following processes: (1) making decisions after multiple assessments and (2) observing the future development. Conclusions: Medical professionals should provide comprehensive information regarding tracheostomy and diseases, fully discuss with decision-makers about the problems concerning patients’ willingness, prognosis and follow-up care, and assess the sufficiency of family support among decision-makers. These strategies could help decision-makers proceed with decision-making and make decisions more relevant to patients’ willingness.