預立醫療照護計畫對老人與潛在代理人於末期照護偏好一致性之探討

柯莉珊

doi:10.6342/NTU201802140

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预立医疗照护计画对老人与潜在代理人於末期照护偏好一致性之探讨

Exploration of Advance Care Planning on an Agreement about the Preferences of End-of-Life Care between Older People and Their Potential Surrogates

柯莉珊 , 博士　　导师：胡文郁　　

繁体中文 DOI： 10.6342/NTU201802140

老人；潜在代理人；末期照护；偏好；预立医疗照护计画；预立医疗照护谘商；预立医疗指示；预立医疗决定； older people ； potential surrogates ； end-of-life care ； perferences ； advance care planning ； advance directives ； advance decisions

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摘要 │ 参考文献 (180) │ 国际计量

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Background: Older people’s age and health condition often made them to be a high risk of incapacity. Family members always substituted for older people to make decisions when they lost capacity. However, studies indicated that family members did not know older people’s preferences toward end-of-life care, and family members’ ability for prediction was poor. Aim: The aim of study was to explore advance care planning on agreement about the preferences of end-of-life care between older people and their potential surrogates. Design: Pretest-posttest control group design was adopted in the study. Participants: Older people with age over than 65 years old and their potential surrogates were recruited at two geriatric wards in a medical center. Measurement: The 36 items of life support preferences questionnaire (LSPQ) was the major measuring tool which includes four medical measures in nine scenarios. Intervention: The brochure of “advance care planning for seniors” was developed for older people. The content of the brochure included three parts: “familiar with advance care planning and advance decision”, “willingness in your medical care”, and “discussion in advance care planning”, separately. During the process of intervention, the researcher would go through this brochure with older people and their potential surrogates to stimulate them to have their own discussion about end-of-life care. The average time of intervention was 28 minutes. Results: Older people only agreed with antibiotics applied on current health, severe dementia, and continuous dyspnea, while older people tended to decline cardiopulmonary resuscitation (CPR), surgery, and nasogastric tube feeding used in all scenarios. Potential surrogates could predict older people’s preferences about CPR in all scenarios, and only could not predict preferences about surgery in two of nine scenarios, which were severe stroke with no recovery and terminal cancer with severe pain. Additionally, potential surrogates had poor prediction about older people’s preferences for antibiotics and nasogastric tube feeding. Using stepwise liner regression model to control other variables, the results showed that “group”, “educational level of older people”, “numbers of children of older people”, “potential surrogates’ own willingness to discuss advance directives (ADs) with family members”, and “relationships of potential surrogates to older people” would affect an agreement about the preferences of end-of-life care between older people and their potential surrogates. Conclusions and suggestions: The intervention could improve an agreement about the preferences of end-of-life care between older people and their potential surrogates. The study suggests that more brochures or media related to advance care planning should be developed based on older people’s specific characteristics, such as cognition or sensory function degradation. In addition, what potential surrogates would make “substitute decision” for older people could be compared in the future study.

参考文献 ( 180 ) 〈TOP〉

蔡甫昌、潘恒嘉、吴泽玫、邱泰源、黄天祥(2006)．预立医疗计画之伦理与法律议题．台湾医学，10(4)，517-536。doi: 10.6320/fjm.2006.10(4).15
连结：
Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach's alpha. International Journal of Medical Education, 2, 53-55. doi: 10.5116/ijme.4dfb.8dfd
连结：
王业兴(2008)清末民初的教育新理念与孙中山近代化教育思想．甘肃社会科学，2008(3)，164-166。
吴柏毅、蔡甫昌、陈庆余(2004)．病患的决定能力．当代医学，368，482-486。李明滨(1997)．病人自主与知情同意．医学教育，1(4)，377-388。
李欣慈、陈庆余、胡文郁(2012)．华人孝道与家庭主义文化脉络下谈长照机构住民执行预立医疗照护计画与老人自主权．安宁疗护杂志，17(2)，187-199。doi: 10.6537/TJHPC.2012.17(2).5

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使用DOI作为永久连结

引用含有DOI的文献

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。 如想对DOI的使用与概念有进一步了解，请参考 （ ） 。

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。如想对DOI的使用与概念有进一步了解，请参考（）。