醫療團隊參與重症病患末期照護決策歷程之探討

A study on the participation process of the medical team in critically ill patients' end-of-life care decision making.

余家偉(Ka-Wai U)

指導教授 ： 陳武宗

高雄醫學大學/健康科學院/醫學社會學與社會工作學研究所/碩士(2011年)

摘要

加護病房的醫療團隊經常需要面對即將面臨死亡的重症病患，為了讓醫療資源得到更合理的運用，同時讓病患能得到善終，醫療團隊都會協助病患及家屬進行相關的末期照護決策。本研究以質性研究方法，透過到腦神經外科加護病房進行田野觀察，以及與醫療團隊成員進行深度透訪談，瞭解醫療團隊參與重症病患末期照護決策的歷程與經驗。研究結果包括：(1) 協助決策歷程的開始是必須讓家屬接受病患即將死亡的事實，以及處理家屬面對病患死亡的心理階段；(2) 醫療團隊透過向家屬提供病患疾病資訊及協助釐清想法，支持家屬進行決策；(3) 家屬是主要的決策者，而家屬間的意見衝突及傳統文化的影響是醫療團隊在工作上的最大挑戰；(4) 醫療團隊的合作為專業間的團隊合作模式，主要建立在工作介入前的資訊交換，並由不同專業各自與家屬進行互動。本研究建議需加強醫療團隊的死亡教育，建構明確的專業分工及工作指引，對社工在器官勸募的角色作改變，以及未來可由病患家屬的觀點作研究。

關鍵字

加護病房 ； 醫療團隊 ； 末期照護決策 ； 不予施行心肺復甦術 ； 器官捐贈 ； 非醫囑自動出院

並列摘要

ICU medical team often needs to face imminent death of critically ill patients. In order to make the use of health care resources more rational, and to allowing patients to get hospice care, medical team will help patients and their families for the decisions related to end-of-life care. This study uses qualitative research, through the field observation in neurosurgery, and depth interviews with the medical team members, to understand about the process and experience of the medical team involved in critically ill patients’ end-of-life care decision making. The result of this study included, (1) to start the assist process of end-of-life care decision-making, medical team must let the families to accept the fact that patients will be dying soon, and help the families dealing with the psychological stages of facing the dying patient; (2) medical team supports the families in decision making through providing disease information and helping them to clarify their mind; (3) family is the main decision-makers, and the conflicting opinions between family members and the influence of traditional culture, are the biggest challenge to medical team dealing with end-of-life care decision making; (4) the collaboration of medical team is in inter-disciplinary model, mainly based on the exchange of information in different professions, and interact with family members in their own. This study suggests strengthening education in the death of the medical team, to construct a clear professional division and guidelines, and to change the role of social worker in organ donating. The future research can understand the point of view of the families in end-of-life care decision making.

並列關鍵字

Intensive Care Unit ； Medical Team ； End-of-life Care Decision Making ； Do-Not-Resuscitate ； Organ Donation ； Against Advice Discharge

參考文獻

中文部分

Frederic G. Reamer 著，包承恩、王永慈、郭瓈灩、鐘曉慧 譯 (2000)。社會工作價值與倫理。台北：洪葉文化。

Thomas Herzog 著，朱柔若譯 (1996)。社會科學研究方法與資料分析。台北：楊智。

李中月 (1997)。加護病房分級認定之檢討。衛生報導，7卷3期，p.22-29。

辛幸珍 (2006)。以家庭為中心之價值觀對老年末期醫療抉擇之影響：比較台灣年老者與紐西蘭老人之觀點。臺灣醫學人文學刊，7卷1&2期，179-190。