影響長期使用呼吸器病患家屬參與氣切手術醫病決策態度之因素探討

The exploration of factors affecting family members’ attitude of shared decision-making about tracheostomy in patients requiring prolonged mechanical ventilation

藍惠如(Hui-Ju LAN)

指導教授 ： 郭青萍

中山醫學大學/醫學院/護理學系/碩士(2020年)

https://doi.org/10.6834/csmu202000214

摘要

背景與目的：根據國民健康署統計，從2001到2010年間，長期使用呼吸器之病患有三倍多的成長，有鑑於國人面對氣切手術照護的需求日益增加，因此探討家屬面對病患接受氣切手術共享醫病決策相關的議題更顯重要。本研究以中部某教學醫院長期使用呼吸器病患的家屬為對象，探討影響其參與氣切手術醫病決策態度的因素。
研究設計與方法：採橫斷式研究設計，以中部某教學醫院亞急性呼吸照護病房為收案地點，立意取樣長期使用呼吸器病患的家屬為對象。以結構性問卷收集個案及家屬基本資料、氣切共享醫病決策認知及共同醫療決策量表的資料。共完成116份完整問卷收集，並以SPSS 22.0版進行資料統計分析。
研究結果：結果發現病患的生活品質及後續照護考量是家屬考慮是否執行氣切手術所在意的因素，而與在意因素相關性最高的是家屬對氣切認知。家屬共享醫病決策與參與治療認知的相關性最高，其次為風險溝通及控制權偏好。而相關重要變項的預測結果顯示:病人意識狀態及家屬氣切認知，可解釋25%家屬控制權偏好的變異量。家屬是否為主要照顧者及家屬氣切認知，可解釋25%家屬參與治療認知的變異量。病人意識狀態、家屬年齡及家屬氣切認知總分，可解釋家屬參與風險溝通27%的變異量。病人意識狀態、家屬年齡及家屬氣切認知，可解釋家屬共享醫病決策態度33%的變異量。
結論與建議：
家屬考慮是否執行氣切手術所在意的因素為病患的生活品質及後續照護的考量，而與在意因素相關性最高的因素為家屬對氣切的認知。病人意識狀態、家屬年齡及其對氣切認知，是影響家屬共享醫病決策態度重要的預測因子。因此，臨床醫護人員在與家屬進行氣切共享決策時，應考慮到病患意識程度及家屬年齡，給予個別化的醫療資訊；並可運用氣切共享醫病決策認知量表，來評估家屬對氣切的認知程度，針對家屬不正確的地方加以澄清，並讓家屬有足夠時間吸收相關醫療資訊和以病患最大利益考量醫療決策方向。

關鍵字

長期使用呼吸器病患家屬 ； 氣切認知 ； 共享醫病決策態度

並列摘要

Background and purpose:
According to the statistics of the Ministry of Health and Welfare from 2001 to 2010 in Taiwan, the growth of prolonged mechanical ventilator patients had been more than three times. In view of this, the issues about health care and medical decision-making for tracheostomy, those are more important gradually. This study aims to explore the factors that influencing family members' attitude about the medical decision-making of tracheostomy.
Research design and method:
This study adopted a cross-sectional design. Using purposive sampling to recruit participants from the sub-acute respiratory care unit of a teaching hospital in the central Taiwan. The structured questionnaire was used to collect demographic data of cases and their families. The scales of tracheostomy's shared medical decision cognition and the shared decision making (SDM) were completed from116 participants. Data had been analyzed with SPSS 22.0.
Results:
This study showed that patient's quality of life and follow-up care issues were the factors affecting family members' consideration about the tracheostomy whether to proceed. Factor existing the strongest correlation to family members' consideration was the family members' cognition of tracheostomy. And the correlation between family members' shared medical decision-making and participation in treatment cognition was the highest, followed by the participation in risk communication and control preferences. The results of prediction factors showed that: The factors of patient's consciousness and family members' tracheostomy cognition could explain 25% of the variations of family members' control preference. The participants whether were the primary caregiver and the family members' cognition about tracheostomy, those factors could explain 25% of the variations of family members' cognition about treatment. The consciousness state of patient, age of family members and the score of tracheostomy cognition of family members, those factors could explain 27% variations about the participation in risk communication of family members. The consciousness state of patient, age of family members and the score of tracheostomy cognition of family members, those factors could explain 33% variations about the shared decision-making attitude of the family members.
Conclusions and recommendations:
The factors that affected family members consider whether to perform tracheostomy are the patient's quality of life and follow-up care issues, and the strongest relating about family members' consideration factor is the family members' cognition of tracheostomy. The consciousness of patient, age of the family members and their cognition of tracheostomy are important predictors that affect the family members' attitude towards shared medical decisions. Therefore, nurses should base on the patient's consciousness and family member's age to give individualized medical information, when making tracheostomy sharing decisions with family members. Nursing staffs can also apply the tracheostomy shared medical decision-making cognition scale to assess family members' cognition situation and clarify the incorrect cognition parts of the family members. Allowing the family members to have enough time to absorb relevant medical information and considering the direction of medical decision-making in the best benefits of patients.

並列關鍵字

family members of patients with long-term use of respirator ； tracheostomy cognition ； shared decision making attitude

參考文獻

參考文獻

中文部分

黃正宜、黃琇梨、張瑛(1997）．呼吸功能障礙病人護理．護理雜誌，44（4），87-93。DOI:10.6224/JN.44.4.87

尹裕君、杜異珍(2000)．氣切患者出院準備服務計劃之執行．榮總護理, 17(4)，383-390。DOI:10.6142/VGHN.17.4.383

吳清平(2000)．全民健康保險“呼吸器依賴病患整合性照護前瞻性支付方式”試辦計畫（核定版）。