頁籤選單縮合
題名 | 病人對預立醫囑的看法--以彰化某醫院家庭醫學科門診病人為例=Perspectives on Advance Directives in Outpatients of Department of Family Medicine in Changhua City |
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作者 | 張惠雯; 顏啟華; 林鵬展; 劉立凡; | 書刊名 | 安寧療護 |
卷期 | 16:3 2011.11[民100.11] |
頁次 | 頁296-311 |
分類號 | 419.77 |
關鍵詞 | 預立醫囑; 預立醫療自主計畫; Advance directives; Advance care planning; |
語文 | 中文(Chinese) |
中文摘要 | 研究目的:預立醫囑可讓患者在自己無能力決定生命末期醫療決策時,藉由書面聲明清楚指引家人及醫療團隊自己想要的醫療方式。為了解台灣病人對預立醫囑的看法,設計自擬式結構問卷。材料與方法:於彰化某醫院家庭醫學科門診收案,從民國99年9月07日至民國100年9月06日止,共計收案一年。以結構式問卷及社會支持量表、生活滿意度量表、憂鬱量表與意願進行交叉分析及統計推論。描述性統計進行各年齡層人口學變項資料分析,推論性統計以邏輯斯複迴歸分析意願相關影響因素。結果:預立醫囑意願單變項分析有意義的相關因素為憂鬱傾向、平均社會支持、生活滿意度、自覺健康、曾參與不急救同意書討論的相關經驗、了解疾病嚴重度及預後及死亡焦慮。經邏輯斯複迴歸分析顯示,希望了解疾病嚴重度及預後(OR = 5.376)及曾參與不急救同意書討論(OR = 2.124)的受試者有意願預立醫囑機會較高。死亡焦慮中「非常害怕」(OR =0.259)及自覺健康同齡比「很好」(OR = 0.280)的受試者有意願預立醫囑機會較低。預立醫囑的意願與社會人口學變項性別、婚姻狀況、居住型態、主要照顧者、主要醫療決定者、社會福利、私人醫療保險、宗教信仰及社會支持無相關。結論:醫護人員適時給予病人靈性支持降低死亡焦慮,引導病患及其家屬討論生命末期醫療決策,可以協助病人早期完成「預立醫療自主計畫」。 |
英文摘要 | Background: The spirit of advance directives (AD) is respecting patient autonomy and to ensure what would be done if they lose the capacity to decide for themselves. Material and Method: We used a structured questionnaire to survey willingness of AD in outpatients of Department of Family Medicine in Changhua city from September 2010 to September 2011. We identified influencing factors of AD by conducting multivariate logistic regression analysis. Results: Significant factors from univariate analysis were depression status, social support, life satisfaction, perceived health status, having experience of discussing "Do Not Resuscitate", being aware of prognosis of disease and fear about death. Logistic regression analysis indicated that preference of AD positively associated with being aware of prognosis of disease (OR = 5.376 ) and having experience of discussing "Do Not Resuscitate" (OR = 2.124 ); negatively associated with severe fear about death (OR = 0.259 ) and perceived health status comparing with peers excellent (OR = 0.280 ). There was no significant relationship on preferences of advance directives between demographic characteristics, social support, depression status and life satisfaction. Conclusion: Medical staff members provide patients with spiritual support to decrease fear about death and raise issue of end-of-life care would facilitate the signing of 「Advance Care Planning」. |
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