成人加護病房病人家屬對器官捐贈意願之探討

Willingness to Donate Organs in Family Members of Intensive Care Unit Patients

陳俞君(Yu-Chun Chen)

指導教授 ： 吳麗珍

長榮大學/健康科學學院/護理學系(所)/碩士(2015年)

https://doi.org/10.6833/CJCU.2015.00030

摘要

器官捐贈供需失衡是全球倡導的社會議題，而台灣礙於現行法制及倫理考量，即使病人生前已簽立器官捐贈意願書或健保卡註記器官捐贈意願，醫療院所仍會徵詢家屬同意及要求家屬簽署器官捐贈同意書。因此在最後時刻，病人家屬往往是器官捐贈最後決策者。本研究旨在探討加護病房病人家屬簽署親人器官捐贈同意書的意願傾向及其影響因素。
本研究採橫斷式研究設計，研究地點取自南部某醫學中心內、外科加護病房。採方便取樣，收案對象為加護病房收住滿24小時病人的親屬、為病人二等親以內的血親或配偶、病人病情穩定或準備轉出加護病房的病人親屬、家屬須年滿20歲以上成年人。以結構式問卷收集資料，收案調查期間為2014年4月至10月，共110位家屬參與，完成110份問卷。問卷內容包含：第一部分為成人加護病房病人家屬之人口學基本屬性及對器官捐贈之相關經驗，第二部分為器官捐贈量表，第三部分為中文版Mishel家屬不確定感量表。問卷資料以SPSS18.0套裝統計軟體進行資料分析。
本研究受訪者年齡範圍為20-65歲（M = 38.04, SD = 10.71），女性人數居多（n = 74, 67.3%），大學畢業者居多（n=53, 48.2%），已婚居多（n =63, 57.3%）。研究結果發現，假設家人生命無法挽救時，71位(64.5%)成人加護病房病人家屬有意願簽署器官捐贈同意書。病人家屬之性別、年齡、教育程度、與病人關係、宗教信仰、婚姻狀況及家庭收入皆與簽署器官捐贈同意書之意願無顯著差異。在病人家屬器官捐贈相關經驗中，僅家人支持與簽署器官捐贈同意書之意願具顯著差異（χ2＝9.07, p＜ .05）。病人家屬對器官捐贈態度趨於正向（M = 81.85, SD = 11.75），與簽署器官捐贈同意書意願傾向呈統計上顯著差異（t=4.81, p＜ .001）。病人家屬對器官捐贈之行為知識屬於中上程度（M =7.29, SD =1.19），與簽署器官捐贈同意書意願傾向呈統計上顯著差異（t=-2.24, p＜ .05）。成人加護病房病人家屬對疾病不確定感介於中間程度，對簽署器官捐贈同意書之意願無顯著差異。依據邏輯斯迴歸分析，家人支持、器官捐贈態度與器官捐贈之行為知識是影響家屬簽署器官捐贈同意書意願傾向的重要預測因子，顯示三個自變項可以解釋簽署器官捐贈同意書意願變數總變異的34%。預測不簽署器官捐贈同意書意願的正確率為51.3%，願意簽署器官捐贈同意書意願的正確率為85.9%。
本研究結果發現家人支持、器官捐贈之態度、器官捐贈之行為知識是影響家屬簽署器官捐贈同意書意願傾向的重要預測因子。因此建議醫護人員或社工師，日後進行器官勸募時，需提供家屬對器官捐贈的正確知識和獲取其他家人對器官捐贈的支持，將能提升家屬願意簽署器官捐贈同意書之機會。

關鍵字

加護病房 ； 器官捐贈 ； 家屬器官捐贈意願

並列摘要

The large gap between demand and supply of organs around the world makes promoting organ donation an important global social issue. In Taiwan, even after someone has already signed consent or registered for organ donation, ethically, the hospital still requires a family member’s written consent before the organ donation can be processed. As a result, the family member rather than the patient makes the final decision. This study investigated the willingness of family members of intensive care units (ICU) patients to sign consent for organ donation for a hypothetical patient with an irreversible condition.
This cross-sectional study included 110 subjects who were recruited through convenience sampling. The study subjects were the family members of patients in intensive care units of a medical center in southern Taiwan. To be included in the study, the patient had to be admitted to the hospital for at least 24 hours and be in a stable condition. The family member had to be 20 to 65 years old and was the patient’s spouse or first-degree or second-degree relative. The data was collected from April 2014 to October 2014. The study instruments consisted of experiences of organ donation, which includes family support, the scale of organ donation, which includes attitude and knowledge of organ donation, and the Mandarin version of Mishel’s scale on family member uncertainty.
The subject’s age ranged from 20 to 65 (M = 38.04, SD = 10.71). The majority were female (n = 74, 67.3%), college graduates (n=53, 48.2%), and married (n =63, 57.3%). The study found that 71 (64.5%) were willing to donate the organs of a hypothetical patient whose condition was irreversible. The subject’s gender, age, education level, relationship to the patient, religion, marriage, and family income did not correlate to the subject’s willingness to sign consent. The level of uncertainty of the patient’s condition did not correlate with willingness to sign consent. However, family support correlated significantly with willingness to sign consent (χ2 = 9.07, p < .05). The subject’s attitude (M = 81.85, SD = 11.75) and knowledge (M = 7.29, SD = 1.19) of organ donation correlated significantly with willingness to sign consent (t = 4.81, p < .001; t = 2.24, p < .05). Based on logistic regression, family support, attitude and knowledge of organ donation significantly predicted 34% of the variance in willingness to sign consent. Using all three independent variables, prediction of unwillingness to sign consent for the hypothetical patient was 51.3% and prediction of willingness to sign consent was 85.9%.
This study found that family support, attitude, and knowledge of organ donation were important factors in predicting willingness to sign organ donation consent for a hypothetical patient. The study suggests that in order to successfully recruit organ donors, nurses and social workers need to consider family support and educate families on organ donation.

並列關鍵字

Intensive Care Unit ； organ donation ； family members’ willingness on organ donation

參考文獻

王秀珍（1999）‧加護病房人家屬需求及其護理‧護理雜誌，46（2），67-71。

史麗珠、劉于綸、黃淑玲（2001）‧北部某護專學生對器官捐贈意願、態度、知識之調查‧長庚護理，12（1），42-51。

杜素珍、史麗珠、廖美南、黃慈心、陳麗娟 （2001）‧器官移植教育對護理人員器官捐贈觀念之影響‧臺灣醫學，5（1），1-9。

柯文哲（2000）‧器官捐贈‧台灣醫學，4（3），275-281。

柯莉珊、樓文菁、莊雯如、張瑞燕、林麗華（2011）‧神經加護病房護理人員對腦死知識、器官捐贈的態度、行為意向及其相關因素之探討‧榮總護理，28（2），172-183。