治療或不治～就是問題所在：老年癌症病人照護的倫理議題

To Treat or Not to Treat, That is the Question ~ Ethical Issues Related Care for Elderly Cancer Patients

張碧容(Pei-Rong Chang) ； 李鳳屏(Feng Ping S. Lee) ； 蕭華岑(Hua-Tsen Hsiao) ； 謝秀芳(Hsiu-Fang Hsieh)

《腫瘤護理雜誌》 15卷2期 (2015/12) Pp. 1-18

https://doi.org/10.3966/168395442015121502001

摘要

老年人罹癌率較高，而隨著我國社會老年人口的遽增，老年癌症病人數也逐年增加。癌症併同原本老化的健康問題，老年癌症病人的健康照護需求也將相對提高，更凸顯第一線的護理人員的所面臨的挑戰。本文彙述老年人的罹病率、死亡率、性別差異、延遲診斷與拒絕治療、預後影響因素等癌症特性，說明老年癌症病人的相關迷思、挑戰與障礙，並探討老年癌症病人如病人決策測量工具、自主決策促進建議、癌症決策中護理人員的角色與功能等治療決策層面議題，同時闡述關係倫理（relational ethics）與莊遜四個盒子模式（Josen's four boxes model）的倫理運用，最後簡述「病人自主權利法」與未來的老年癌症病人照護重點。本文目的在提供護理人員老年癌症病人的相關實證護理知識，期勉能轉譯成每日的臨床照護實務，同時，提出未來相關研究的建議，以期真正瞭解老年癌症病人的需求與癌症決策，進而落實關係倫理的實踐，以提升我國老年癌症病人的照護品質。

關鍵字

老年癌症 ； 倫理議題

並列摘要

As the cancer incidence is higher in the aging population, the climbing number of the elderly in Taiwan contributes to the exponential rise of cancer in geriatric patients. In addition to the expected geriatric health issues, increase in that cancer population means higher demand for geriatric oncologic care, which presents a growing challenge for healthcare professionals, especially the frontline nurses. In light of such trend, we examined the characteristics of the elderly cancer patients in terms of prevalence, mortality rate, gender difference, delay in diagnosis, refusal of treatment, and prognostic factors with the cancer treatment/care related misconceptions, challenges, and obstacles deliberated. This paper explored the area of cancer treatment decision, such as the measurements, strategies for autonomy enhancement, and the roles and functions of nurses involved in the process of decision making. Relational ethics was depicted and Josen’s four boxes model was applied in ethical dilemma. This paper concluded with Taiwan’s ＂Patient Self-Determination Act＂ and recommendation of care guidelines for elderly cancer patients. With this paper, we hope to provide the oncology nurses with evidence-based knowledge that can be transferred to clinical care guidelines. We also hope our recommendations on future research can help us better understand the needs of elderly cancer patients and to engage in the implementation of relational ethics for quality oncologic care for the elderly in Taiwan.

並列關鍵字

Elderly cancer patients ； Ethical issues

參考文獻

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