社區慢性病老人對無效醫療看法之探討

鑑於無效醫療的研究多著重在醫療人員或倫理法律學家的見解，缺少民眾立場的觀點，本質性研究旨在探討居住於社區，75歲以上，且患有慢性病老人對無效醫療之看法。研究者以立意取樣收案，個別訪談9位居住於台南地區老人，將半結構式訪談過程，全程錄音，並轉錄為逐字稿。訪談資料以內容分析法進行分析，最後歸納五個主要主題與十三個次主題所構成。主題與次主題分別為：（1）感受無效處置存在－寄望醫療科技、依賴健保之福利、延長生命的痛苦、討論死亡議題；（2）重度慢性病造成家庭負荷－久病拖累家庭成員、加重經濟負擔、影響自身與家人情緒；（3）聽從醫師建議－尊重專業；（4）與慢性病共存－學習與疾病共處、重視銀髮健康、找尋社會支持；（5）醫療指示需及時－接受安寧意願高、對預立醫療指示存有不確定感。本研究結果可促使醫療相關單位及政府重視民眾對無效醫療的看法，進而帶動社區高齡長者對安寧療護和病人自主權利相關知識之提升。

關鍵字

社區老人；慢性病；無效醫療

並列摘要

Most studies of futile care focus on the perspective of ethicists, lawyers, and health care providers. This qualitative study explores perceptions of medical futility in community-dwelling older adults 75 years or older with chronic illnesses. Nine older adults were recruited through purposive sampling to participate in individual face-to-face interviews. These semi-structured interviews were audio-taped, transcribed verbatim and analyzed by content analysis. Five themes and thirteen sub-themes emerged from the data: (1) Sense of medical futility: expectations of medical technology, dependence on the National Health Service, prolonging the agony of life, discussion of death-related issues; (2) Severe chronic disease as a caregiver’s burden: encumbering family members, financial burden, physical and psychological burden; (3) Compliance with the physician's advice: respect toward professionals; (4) Living with chronic disease: learning to live with the disease, watching for health problems, looking for social support; and (5) Documenting advance directives in a timely manner: favoring palliative care, uncertainty regarding advance directives. Study findings may help health-related institutions understand medical futility from the perspective of health care consumers, which will allow them to better inform community-dwelling old adults about palliative care and the Patient Autonomy Bill.

並列關鍵字

community-dwelling older adults ； chronic illnesses ； medical futility

參考文獻

安寧緩和醫療條例（2013，1月）。取自http://www.tho.org.tw/xms/

江蓮瑩（2015）．加護病房護理人員的無效醫療經驗（未發表碩士論文）．台中：中山醫學大學護理研究所。 [Chiang, L. Y. (2015). Intensive care nurses' experience of medical futility (Unpublished master’s thesis). Taichung : Department of Nursing, Chung Shan Medical University, Taiwan, ROC.]

李世代(2002) ．長期照護之概說‧當代醫學，29（1），60-69。[Lee, S. D. (2002). Long-Term Care, Medicine Today ,29(1), 60-69. ]

辛幸珍(2006) ．以家庭為中心之價值觀對老年末期醫療抉擇之影響－比較台灣年老者與紐西蘭老人之觀點‧台灣醫學人文學刊，7（1、2），179-190。[Hsin, H.C.(2006). Effects of family-centered Values in Elder's end-of-life Decision making-Perspectives of Seniors in Taiwan and Compared to Seniors in New Zealand, Formosan Journal of Medical Humanities,7(1.2), 179-190. ]

林芳如、黃勝堅、吳春桂、黃美玲、林亞陵、蘇玲華、蔡紋苓、林宏茂（2010）．重症生命末期無效醫療之探討‧中華民國急救加護醫學會雜誌，21，1-8。[Lin , F. R., Huang, S. J., Wu, C. K., Huang, M. L., Lin, Y. L., Tsai, W. L., Su, L. H., ＆Lin, H. M. (2010). Medical Futility in Critical End-of Life Care. Journal of Emergency and Critical Care Medicine, 21, 1-8.]

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社區慢性病老人對無效醫療看法之探討

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