- 期刊
安寧緩和醫療知識態度臨床技能問卷調查文獻分析
Literature Analysis of Knowledge Attitude Practice Questionnaires in Hospice Palliative Care
摘要
安寧緩和醫療是醫學教育不可或缺的一部份，評量醫師或醫學院學生對於末期照顧的知識、態度和臨床技，對於改善末期照顧品質有很大的幫助。我們從Medline找尋最近十年內有關醫師或醫學院學生，對末期照顧的知識、態度和技能的國內外文獻，結果找到附有評估量表或問卷者的國外文獻共有7篇，而本緩和醫療病房既有的評估問卷則有2篇。我們根據本緩和醫療病房訓練醫學院學生和住院醫師的核心內容，分別訂出末期照顧方面的三要項（知識、態度和臨床技能）的主要成分，「知識」要項細分為「症狀控制」、「心理抜持」、「家庭互動」、「社會網絡資源」、「靈性輔導」、和「基本理念與原則」等六個成分，「態度」要項則分為「末期照顧的決策」、「緩醫療」、「病情告知」、「接受死亡」、「家屬哀慟輔導」和「其他相關議題」等六個成分，「臨床技能」要項則詳列「病史詢問」、「理學檢查」、「床邊照顧技巧」、「家庭會議」和「病例報告與分享」等五個成分。我們對於各篇問卷加以整理分析，綜合結果顯示調查對象仍以醫師或住院醫師居多（67%），「知識」要項以「症狀控制」為最多，「心理支持」次之，至於「靈性輔導」則付之闕如。「態度」要項以「緩和醫療」佔第一位，「末期照顧的決策」和「病情告知」則次之。「臨床技能」要項在所有目卷量表中完全沒有提及。「症狀控制」以有關疼痛的部分佔第一位（74%），呼吸困難居第二位（80%）；「緩和醫療」則最多提及「照顧方式」（61%），其次是有關「理念、目標」（35%）。檢視問卷與量表的內容，加入「靈性輔導」成分與「臨床技能」要項的評量，作為日後本緩和醫療病房訂立全面性評量問卷的依據與參考。
並列摘要
Hospice palliative care is a vital part of medical education. Evaluating the knowledge, attitudes and clinical skills about end-of-life care will improve the quality of terminal illness care. We searched from the Medline 1994 to 2003 with the key words about end-of-life care knowledge, attitudes and clinical skills of physician or medical students. We got 7 foreign articles attached to evaluation scale or questionnaire and 2 questionnaires used in our palliative care unit. According to core contents of training medical students and residents in palliative care, we used the framework of 3 main domains (knowledge, attitudes and clinical skills) regarding to the quality end-of-life care. “Knowledge” domain divided into “Symptom control”, “Psychological support”, “Family dynamics”, “Social network resources”, “Spiritual support”, and “Basic concepts and principles”. “Attitude” domain divided into “Decision making about end-of-life care”, “Palliative care”, “Truth telling”, “Acceptance to death”, “Family bereavement support”, and “Other relevant issues”. “Clinical skills” domain divided into History taking”, “Physical examination”, “Bed-side care skills”, “Family meeting” and “Case report and share”. The results showed the targeted objects were physicians or residents (67%). “Knowledge” domain revealed that “Symptom control” the highest, and “Psychological support” the second. “Attitude” domain revealed that “Palliative care” occupied the first place, and “Acceptance to death” the second. “Clinical skills” domain was not included in all questionnaire. “Symptom control” component showed that pain the most common (74%), dyspnea the second (8%); “Palliative care” component was “care pattern” (61%) the most, “Concept and aim” (35%) the most ° The study suggested integrating with “Spiritual support” component and “clinical skills “domain into forthcoming questionnaire in measuring quality end-of-life care.