某緩和病房小兒癌末病人善終服務

Good Death Assessment of Pediatric Patients with Terminal Cancers at a Palliative Care Unit

許馨文(Hisn-Wen Hsu) ； 胡文郁(Wen-Yu Hu) ； 程劭儀(Shao-Yi Cheng) ； 姚建安(Chien-An Yao) ； 陳慶餘(Ching-Yu Chen) ； 邱泰源(Tai-Yuan Chiu)

《安寧療護雜誌》 10卷4期 (2005/11) Pp. 358-370

https://doi.org/10.6537/TJHPC.2005.10(4).4

摘要

Cancer is the leading cause of non-accidental death in childhood. There has, however, been few studies about palliative care for children dying of cancer. The objectives of this study were to assess the score of good death of terminal cancer patients, to compare the differences of the score of good death between pediatric and non-pediatric patients and to investigate the possible influential factors. A total of 1031 terminal cancer patients died between April 2000 and March 2004 had been enrolled. We assessed ”the index of good death” and ”the services for good death” for each patient in the weekly team meetings. ”The index of good death” included the assessment of patients' awareness, acceptance, propriety, timeliness and comfort before death. ”The services for good death” covered the assessment of care, control, composure, communication, continuity and closure. Results based on ”the index of good death” showed that the pediatric terminal cancer patients had lower scores in the assessment of awareness, acceptance, propriety, timeliness and comfort before death, but the performance in all of these aspects doesn't reach a significant difference. Results based on ”the services for good death” showed that pediatric terminal cancer patients had a higher total score. They had higher scores in the assessment of control, composure, communication, continuity and closure (p＞0.05), and the performance in the assessment of closure even reached a significant difference (p＜0.05). This study showed that although the team workers made lots of efforts to take care of those pediatric terminal cancer patients, their scores of good death were still lower than those of non-pediatric terminal cancer patients. Investigation of the reasons showed that truth telling is an important factor influencing the good death. The results suggest an important need to increase pediatric palliative care training to team workers. The palliative care team has to improve their communication between parents and children dying of cancer.

關鍵字

緩和醫療 ； 小兒 ； 癌末 ； 善終

並列摘要

Cancer is the leading cause of non-accidental death in childhood. There has, however, been few studies about palliative care for children dying of cancer. The objectives of this study were to assess the score of good death of terminal cancer patients, to compare the differences of the score of good death between pediatric and non-pediatric patients and to investigate the possible influential factors. A total of 1031 terminal cancer patients died between April 2000 and March 2004 had been enrolled. We assessed ”the index of good death” and ”the services for good death” for each patient in the weekly team meetings. ”The index of good death” included the assessment of patients' awareness, acceptance, propriety, timeliness and comfort before death. ”The services for good death” covered the assessment of care, control, composure, communication, continuity and closure. Results based on ”the index of good death” showed that the pediatric terminal cancer patients had lower scores in the assessment of awareness, acceptance, propriety, timeliness and comfort before death, but the performance in all of these aspects doesn't reach a significant difference. Results based on ”the services for good death” showed that pediatric terminal cancer patients had a higher total score. They had higher scores in the assessment of control, composure, communication, continuity and closure (p＞0.05), and the performance in the assessment of closure even reached a significant difference (p＜0.05). This study showed that although the team workers made lots of efforts to take care of those pediatric terminal cancer patients, their scores of good death were still lower than those of non-pediatric terminal cancer patients. Investigation of the reasons showed that truth telling is an important factor influencing the good death. The results suggest an important need to increase pediatric palliative care training to team workers. The palliative care team has to improve their communication between parents and children dying of cancer.

並列關鍵字

palliative care ； pediatric ； terminal cancer ； good death