探討台北市簽署預立醫療決定意願人之區域特性

Regional Characteristics of the Willingness of people for completing Advance Care Planning and Advance Decisions in Taipei City

吳曉聞(Hsiao-Wen Wu) ； 李沂蓁(Yi-Jhen Lee) ； 楊啟正(Chi-Cheng Yang) ； 楊君宜(Chun-Yi Yang) ； 許家禎(Chia-Chen Hsu)

《安寧療護雜誌》 25卷3期 (2021/07) Pp. 205-222

https://doi.org/10.6537/TJHPC.202107_25(3).01

摘要

目的：病人自主權利法期能保障民眾尊嚴善終與拒絕無效醫療。然而推行至今僅有少部分民眾採取行動，因此本研究欲探討臺北市簽署預立醫療決定意願人之區域特性，以利後續擬定推廣預立醫療照護諮商及預立醫療決定的策略。方法：採用次級資料分析法，於2019年度共2,324位意願人參與研究。分析內容包括院區別、性別、年齡、來源別（是否為本院病患或員／志工）、方式別（進行方式是在醫院或社區居家）、是否有醫療委任代理人（Health Care Agent, HCA）、是否有二等親、是否有照顧經驗、身分別（一般民眾或具有社福相關身分）、諮商動機，以及預立醫療決定的選擇。結果：不同院區的意願人在來源別、方式別、是否有HCA、是否有二等親、是否有照顧經驗、身分別、諮商動機等變項呈現顯著差異。相較於其他院區，D院區在社區居家進行預立醫療照護諮商及無二等親參與之比例較高、E院區指定HCA的比例最高、F院區有照顧經驗及身分別為身心障礙者的比例較高；諮商動機多數人皆選擇期待尊嚴善終及預作生命安排。預立醫療決定則有近九成意願人在五款臨床條件下皆選擇不希望接受維持生命治療或人工營養及流體餵養。結論：有鑑於區域發展狀況影響人口健康狀態並會呈現出不同醫療利用情形，不同區域的意願人可能因利他觀點、教育程度及家庭功能等不同因素而影響其簽署預立醫療決定的狀態。本研究建議後續推行預立醫療照護諮商時，需要考慮所在區域而著重不同的策略。

關鍵字

病人自主權利法 ； 預立醫療照護諮商 ； 預立醫療決定 ； 區域特性

並列摘要

Purpose: The Patient Right to Autonomy Act protects people's dignity of good death from invalid medical treatments. However, only few people have taken action so far. Therefore, this study aimed to explore the regional characteristics of the willingness of people in Taipei city, to complete advance care planning (ACP) and advance decision (AD). Method: Using the secondary data analysis method, we analyzed 2,324 people who had implemented the process of ACP in the various districts of Taipei City Hospital in 2019. Analyzing contents include branches, gender, age, sources(patient or staff/volunteer of the hospital or not), method(ACP in the hospital or community), having Health Care Agent (HCA) or not, having second degree of kinship or not, having caring experience or not, identification of social welfare, motivation to consult, and AD selections. Results: The willingness of people in different hospital branches showed significant difference in terms of source, method, having HCA or not, having second degree of kinship or not, having caring experience or not, identification of social welfare, and motivation to consult. Comparing five branches, Branch D had higher ratio of ACP in community and no second degree of kinship; Branch E had higher ratio of having HCA; Branch F had higher ratio of having caring experience and identity of physically and mentally handicapped. In the motivation to consult, most people chose and expected dignity of good death and advance arrangements for life. According to the advance decision, nearly 90% of the willingness of people chose not to receive life-sustaining treatment or artificial nutrition and hydration when the five clinical conditions occur. Conclusion: In view of the regional development affects the health status of the population, the willingness of people in different regions' status of signing AD might be affected by different factors such as altruistic values, education levels, and family functions. This study recommends the future promotion activities of ACP should adopt difference strategies according to regional difference.

並列關鍵字

patient right to autonomy act ； advance care planning (ACP) ； advance decision (AD) ； regional characteristics

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