- 學位論文
探討心衰竭病人簽署「預立醫療決定書(AD)」行為意向之相關因素
Exploring Factors Associated with Behavioral Intention of Patients with Heart Failure to Sign "Advanced Medical Decision (AD)"
摘要
背景:心衰竭病程進展到晚期，身心靈的痛苦及死亡的高風險，對病人、家屬及醫療人員都是龐大的挑戰與負擔，因風俗民情國人避諱討論死亡，因此很少討論與病人末期醫療決策相關的話題。 目的:本研究運用計劃行為理論，探討影響心衰竭病人簽署預立醫療決定書意圖的相關因素。 方法:本研究採用橫斷式設計，研究對象為某中部醫學中心心衰竭病人共收案125位，採結構式問卷收集資料，包含人口學變項、態度、主觀規範、知覺行為控制等三大變項及簽署預立醫療決定書的行為意圖，使用SPSS 22軟體進行統計，探討態度、主觀規範和知覺行為控制等因素，與簽署預立醫療決定書行為意圖之間的相關性。 結果:研究結果顯示， 78.4％的研究對象在有機會時有簽署預立醫療決定書的意圖，而面臨生命末期時有95.2％的研究對象有簽署預立醫療決定書的意圖。人口學變項:自覺健康狀況差、參與過安寧緩和醫療課程或活動、已簽署「安寧緩和醫療意願書」、與家人討論過死亡話題及家人同意簽署預立醫療決定書的研究對象更有簽署意圖。計畫行為理論變項中，態度、主觀規範和知覺行為控制對有機會簽署預立醫療決定書的意圖解釋力為54.2％，有顯著影響(F = 49.9, p < .05)，對生命末期簽署預立醫療決定書意圖的解釋力為69％，有顯著影響(F = 93.0, p < .05)，以知覺行為控制對意圖的影響最大。在態度、主觀規範、知覺行為控制與意圖之間的關係，皆有正相關影響，研究對象對自己作主簽署預立醫療決定書的評價愈高及對簽署預立醫療決定書的態度是好的、有價值及有益的，影響簽署意圖也愈高；在主觀規範上，家人及醫療團體的支持和認同能促進簽署的意圖。 結論:本研究提供了對心臟衰竭病人在面對簽署預立醫療決定書時影響的因素，也強調與家人和醫療團隊之間的支持和溝通的重要性。增強簽署預立醫療決定書的正向態度，強化醫療團隊的建議及支持、制定相應的醫療決策和提供適切照護，建立家人的支持及死亡議題討論，推廣預立醫療決定相關資訊與教育，提供相關諮詢及支持服務可提高簽署預立醫療決定書的行為意圖。
並列摘要
Background: The progression of heart failure to its late stages brings immense physical, emotional, and spiritual suffering, along with a high risk of death. These factors present significant challenges and burdens to patients, families, and healthcare providers. Due to cultural taboos and customs, discussions about death are often avoided, leading to a lack of conversation about end-of-life medical decisions. Objective: This study utilizes the Theory of Planned Behavior to explore the factors influencing the intention of heart failure patients to sign an advance medical directive. Methods: The study employed a cross-sectional design, with 125 heart failure patients from a medical center in central Taiwan. Structured questionnaires were used to collect data, including demographic variables, attitudes, subjective norms, perceived behavioral control, and the intention to sign an advance medical directive. SPSS 22 software was used for statistical analysis to explore the correlations between attitudes, subjective norms, perceived behavioral control, and the intention to sign an advance medical directive. Results: The findings showed that 78.4% of the subjects intended to sign an advance medical directive when given the opportunity, and 95.2% intended to do so at the end of life. Demographic variables such as poor self-perceived health status, participation in palliative care courses or activities, signing a "Palliative Care Willingness Form," discussing death with family, and family agreement to sign an advance medical directive were associated with a higher intention to sign, in terms of the Theory of Planned Behavior variables, attitudes, subjective norms, and perceived behavioral control explained 54.2% of the intention to sign an advance medical directive when given the opportunity, with a significant effect (F = 49.9, p < .05), and 69% at the end of life, with a significant effect (F = 93.0, p < .05), with perceived behavioral control having the most significant impact. Positive correlations were found between attitudes, subjective norms, perceived behavioral control, and intention, with higher evaluations and positive attitudes towards signing an advance medical directive leading to higher intention. Regarding subjective norms, support and recognition from family and medical teams could enhance the intention to sign. Conclusion: This study provides insights into the factors affecting heart failure patients' intentions to sign an advance medical directive and emphasizes the importance of support and communication between family members and medical teams. Recommendations include: enhancing positive attitudes toward signing an advance medical directive, strengthening medical team recommendations and support, formulating corresponding medical decisions and providing appropriate care, establishing family support and discussions on death, promoting information and education related to advanced medical directives, and offering related counseling and support services increases the intention to sign an advance medical directive.