預立醫療照顧計畫服務經驗之探討──以臺北市立聯合醫院為例

本研究旨在探討臺北市立聯合醫院醫療團隊成員進行「預立醫療照顧計畫」之執行經驗，了解第一線實務工作者的醫療團隊成員透過「預立醫療照護諮商」協助人們進行善終意願抉擇、簽署「預立醫療決定」時，可能面臨之問題與困境。本研究採用質性研究方法，針對7名第一線實務工作者(含2名醫師、2名護理師、3名社工師)，透過深度訪談的方法，深入瞭解他們的服務歷程。本研究的研究結果為：壹、預立醫療照顧計畫的目標：預立醫療照顧計畫在於協助意願人促成與醫療團隊及其親友之溝通，亦具有教育性目的與行政性目的。貳、社工角色的重責大任：醫療團隊成員在服務過程中各司其職，其中社工被賦予多樣的功能性。參、服務過程的困境：法案尚未正式施行，缺乏法效力影響參與意願、法定參與者眾多，時間調配上窒礙難行、法定條件針對參與者之限制、院方施予團隊時間壓力、收案來源的不穩定性、意願人及其家屬意見不一、諮商時間過於冗長、預立醫療決定範本的概念模糊等等困境。肆、醫療團隊成員需具備知能：開放的生死觀與善終觀念之認同、安寧緩和訓練課程之具備、瀕死或生命末期經驗、充分了解法規常識、詳加熟悉執行流程、專業溝通技能之養成。本研究依據研究發現進行後續討論，並就實務執行層面、教育訓練層面、制度發展層面提出建議，以供未來實務與政策參考。

關鍵字

預立醫療照顧計畫；預立醫療決定；病人自主權利法

並列摘要

This study aims to investigate the Taipei City Hospital healthcare team’s experience implementing “Advance Care Planning”. This is to understand how first-line healthcare team members use “Advance Care Planning” to help people with hospice care intent as well as cope with potential problems and predicaments when signing “Advance Directives”. The study uses qualitative research methods and focuses on 7 first-line workers (including 2 doctors, 2 registered nurses, and 3 social workers). In-depth interview methods are utilized to thoroughly understand their service processes. Study findings are as follows: I. The goal of Advance Care Planning: the ACP is to assist those with intent to communicate with healthcare team as well as their friends and family. It also has educational as well as administrative purposes. II. Major responsibilities of social workers: healthcare team members have their own respective duties to fulfill in the service process. Among them, the social worker is given diverse functionalities. III. Predicaments in service processes: since the act has yet to be officially enforced, lack of force and effect impacts participation intent. There are many legal participants which hampers scheduling. Legal criteria have restrictions on participants. There is also pressure from the court placed on the healthcare team, case source instability, lack of consensus between persons of intent as well as their respective family members, extensive consultation time, and vague concept of advanced directive templates etc. IV. Healthcare team members must possess knowledge and capabilities: an open view of life and death as well as recognition of good death concept, training in hospice and palliative care, near death or end-of-life experience, adequate understanding of common legal knowledge, familiarity with processes, and development of professional communication skills.

並列關鍵字

Advance Care Planning ； Advance Directives ； Patient Autonomy Act

參考文獻

Huang, C., Hu, W., Chiu, T., & Chen, C. (2008). The practicalities of terminally ill patients signing their own DNR orders － A study in Taiwan. Journal of Medical Ethics, 34, 336-340. http://dx.doi.org/10.1136/jme.2007.020735

Levin, T. T., Li, Y., Weiner, J. S., Lewis, F., Bartell, A., Piercy, J., & Kissane, D. W. (2008). How do-not-resuscitate orders are utilized in cancer patients: Timing relative to death and communication-training implications. Palliative and Supportive Care, 6, 341-348. http://dx.doi.org/10.1017/S1478951508000540

中文文獻