社區民眾對於預立醫療決定行為意向及其相關因素之探討

Advance Decision Behavioral Intention and Related Factors in Adults Living in the Community

10.6224/JN.202306_70(3).08

趙秀琴(Hsiu-Chin CHAO)；蕭雅竹(Ya-Chu HSIAO)；溫明達(Ming-Dar WOON)；黃翠媛(Tsuey-Yuan HUANG)

病人自主權利法 ； 預立醫療決定態度 ； 預立醫療決定行為意向 ； 靈性健康 ； 社會支持 ； Patient Rights to Autonomy Act ； advance decision attitude ； behavior for advance decision ； spiritual health ； social support

護理雜誌

70卷3期（2023 / 06 / 01）

54 - 65

繁體中文;英文

背景：醫療科技進步，不健康存活年數逐年增加。為使病人臨終時家屬面臨末期醫療決策時有所依循，降低無效醫療，提高生活品質與善終，瞭解民眾對於預立醫療決定行為意向及其相關因素，才能有效提高其決策能力。目的：探討社區民眾對於預立醫療決定行為意向與其相關因素。方法：本研究採橫斷性研究設計，針對社區民眾，以紙本與網路問卷方式進行基本屬性、預立醫療決定的經驗、預立醫療決定知識、態度、行為意向、靈性健康、社會支持之資料收集。統計方式以描述性統計與獨立樣本t檢定、單因子變異數分析、皮爾森積差相關分析、多元迴歸分析等推論性統計。結果：共377位社區民眾參與本研究（平均年齡為50.57歲，SD=13.39，58.4%女性），其預立醫療決定行為意向高，假如未來處於永久性植物人狀態時，會拒絕氣管內管插管（4.13分，SD=0.92）、葉克膜（4.09分，SD=0.95）、體外心臟按摩（4.08分，SD=0.95）、心臟電擊（4.08分，SD=0.98）急救措施為較高分項目。預立醫療決定行為意向重要預測因子為性別、有書面表達生命末期醫療決策、會參加病人自主權利法及預立醫療決定的宣導講座、預立醫療決定態度、與社會支持（R^2=40.1%, p<.001）。結論／實務應用：本研究發現社區民眾的預立醫療決定行為意向及重要影響行為因素，為未來提升民眾預立醫療決定簽署率等相關政策措施重要參考。

Background: Improvements in medical science and technology have increased the average number of years that older adults survive with impaired quality of life. Understanding behavioral intentions and related factors affecting advance decision (AD) decision-making can help medical professionals improve the decision-making ability of patients, allowing patients and their family members to make better medical decisions that reduce ineffective medical treatments, improve quality of life, and facilitate a good death. Purpose: This study was developed to explore behavioral intentions and related factors during the process of AD decision-making among community adults. Methods: A cross-sectional study design was used in this study. The knowledge, attitudes, and behavioral intentions regarding AD decisions, spiritual health, and social support were measured in a convenience sample using physical or internet-based questionnaires. Data were analyzed in SPSS 21.0 using descriptive and independent samples t-tests, one-way ANOVA, Pearson correlation, and multiple regression analysis. Results: Three hundred and seventy-seven community adults participated in this research (50.57 years old, SD = 13.39; 58.4% female). The average level of AD-related behavioral intention was found to be high, with high numbers of participants indicating that they would refuse endotracheal intubation (4.13, SD = 0.92), extracorporeal membrane oxygenation (4.09, SD = 0.95), extracorporeal heart massage (4.08, SD = 0.95), and defibrillation (4.08, SD = 0.98) if they were in a permanent vegetative state in the future. The important predictors of AD behavioral intention included gender, written expression of end-of-life medical decision-making, participation in the patient self-rights law and advance decision publicity lectures, having an advance decision attitude, and social support (R^2 = 40.1%, p < .001). Conclusion/ Implications for Practice: A high level of AD-related behavioral intention was found in the sample and several important factors that influence related behaviors were identified. These results provide an important reference for related public policymakers to increase the percentage of older patients participating in advance directive decision-making.

1. 吳佳穎, C.-Y.,陳端容, D.-R.,黃心慈, S.-T.(2020)。住院病患家屬對病人自主權利法的認知、態度及預立醫療決定的行為意向。台灣公共衛生雜誌，39(3)，342-349。
   連結：
2. 蔡宗達, Z.-D.,楊君宜, C.-Y.(2019)。推動預立醫療照護諮商之經驗－以臺北市立聯合醫院為例。長期照護雜誌，23(3)，177-183。
   連結：
3. 蕭玉霜, Y.-S.,葉淑惠, S.-H.(2018)。吞嚥障礙者營養照護之現況與展望。榮總護理，35(1)，2-9。
   連結：
4. 安寧緩和醫療條例，總統華總一義字第11000003571號令修正（2021，1月20日）。[Hospice Palliative Care Act, President’s Order of Hua Chung (1) Yi Tze No. 11000003571 amended. (2021, January 20).] https://mohwlaw.mohw.gov.tw/FLAW/FLAWDAT01.aspx?lsid=FL013632
5. 病人自主權利法，總統華總一義字第11000003561號令修正（2021，1月20日）。[Patient Right to Autonomy Act, President’s Order of Hua Chung (1) Yi Tze No. 11000003561 amended. (2021, January 20).] https://mohwlaw.mohw.gov.tw/FLAW/FLAWDAT0202.aspx?lsid=FL079241
6. Best, M.,Butow, P.,Olver, I.(2014).The doctor’s role in helping dying patients with cancer achieve peace: A qualitative study.Palliative Medicine,28(9),1139-1145.
7. Buck, K.,Nolte, L.,Sellars, M.,Sinclair, C.,White, B. P.,Kelly, H.,Macleod, A.,Detering, K. M.(2021).Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators.Health Expectations,24(4),1312-1325.
8. Chan, C. W. H.,Wong, M. M. H.,Choi, K. C.,Chan, H. Y. L.,Chow, A. Y. M.,Lo, R. S. K.,Sham, M. M. K.(2019).Prevalence, perception, and predictors of advance directives among Hong Kong Chinese: A population-based survey.International Journal of Environmental Research and Public Health,16(3),365.
9. Chou, H.-H.(2020).Exploring the issues of advance directives in patients with mild dementia in Taiwan.Acta Medica Okayama,74(3),215-220.
10. Chu, L.-W.,Luk, J. K. H.,Hui, E.,Chiu, P. K. C.,Chan, C. S. Y.,Kwan, F.,Kwok, T.,Lee, D.,Woo, J.(2011).Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong.Journal of The American Medical Directors Association,12(2),143-152.
11. De, D.,Thomas, C.(2019).Enhancing the decision-making process when considering artificial nutrition in advanced dementia care.International Journal of Palliative Nursing,25(5),216-223.
12. Fang, L.,Hsiao, L.-P.,Fang, S.-H.,Chen, B.-C.(2020).Pre-dictors for the intentions of signing advance directives among dialysis patients: A quantitative study.Contemporary Nurse,56(3),242-254.
13. French, E. B.,McCauley, J.,Aragon, M.,Bakx, P.,Chalkley, M.,Chen, S. H.,Christensen, B. J.,Chuang, H.,Côté-Sergent, A.,De Nardi, M.,Fan, E.,Échevin, D.,Geoffard, P.-Y.,Gastaldi-Ménager, C.,Gørtz, M.,Ibuka, Y.,Jones, J. B.,Kallestrup-Lamb, M.,Karlsson, M.,Kelly, E.(2017).End-of-life medical spending in last twelve months of life is lower than previously reported.Health Affairs,36(7),1211-1217.
14. Graw, J. A.,Burchard, R.(2021).Completion rates of advance directives in a trauma emergency room: Association with age.Emergency Medicine International
15. Holt-Lunstad, J.(2018).Why social relationships are important for physical health: A systems approach to understanding and modifying risk and protection.Annual Review Psychology,69(1),437-458.
16. Huang, Y.-L.,Yates, P.,Thorberg, F. A.,Wu, C.-J.(2022).Influence of social interactions, professional supports and fear of death on adults’ preferences for life-sustaining treatments and palliative care.International Journal of Nursing Practice,28(4),e12940.
17. Kang, L.,Liu, X.-H.,Zhang, J.,Shan, P.-Y.,Wang, J.-P.,Zhong, P.,Du, X.-H.,Du, Y.-F.,Yu, B.-C.,Wei, N.,Lou, H.-L.,Bian, O.,Chen, H.-H.,Lin, F.,Zhou, H.-L.,He, W.,Long, H.-C.,Hong, L.-R.,Su, H.,Chen, L.-K.(2017).Attitudes toward advance directives among patients and their family members in China.Journal of the American Medical Directors Association,18(9),808.e7-808.e11.
18. Kim, B.,Choi, J.,Lee, I.(2022).Factors associated with advance directives documentation: A nationwide cross-sectional survey of older adults in Korea.International Journal of Environmental Research and Public Health,19(7),3771.
19. Ko, E.,Lee, J.,Hong, Y.(2016).Willingness to complete advance directives among low-income older adults living in the USA.Health and Social Care in the Community,24(6),708-716.
20. Laranjeira, C.,Dixe, M. D. A.,Gueifão, L.,Caetano, L.,Passadouro, R.,Querido, A.(2021).Awareness and attitudes towards advance care directives (ACDs): An online survey of portuguese adults.Healthcare,9(6),648.
21. Leong, S. M.,Tam, K. I.,Che, S. L.,Zhu, M. X.(2021).Prevalence and predictors of willingness to make advance directives among Macao Chinese.International Journal of Environmental Research and Public Health,18(15),7942.
22. McAfee, C. A.,Jordan, T. R.,Cegelka, D.,Polavarapu, M.,Wotring, A.,Wagner-Greene, V. R.,Hamdan, Z.(2022).COVID-19 brings a new urgency for advance care planning: Implications of death education.Death Studies,46(1),91-96.
23. Ni, P.,Wu, B.,Lin, H.,Mao, J.(2021).Advance directives and end-of-life care preferences among adults in Wuhan, China: A cross-sectional study.BMC Public Health,21(1),2042.
24. Rego, F.,Gonçalves, F.,Moutinho, S.,Castro, L.,Nunes, R.(2020).The influence of spirituality on decision-making in palliative care outpatients: A cross-sectional study.BMC Palliative Care,19(1),22.
25. Vilpert, S.,Borrat-Besson, C.,Maurer, J.,Borasio, G. D.(2018).Awareness, approval and completion of advance directives in older adults in Switzerland.Swiss Medical Weekly,148(2930),w14642.
26. Wilson, D. M.,Houttekier, D.,Kunju, S. A.,Birch, S.,Cohen, J.,MacLeod, R.,Hewitt, J. A.(2013).A population-based study on advance directive completion and completion intention among citizens of the western Canadian province of Alberta.Journal of Palliative Care,29(1),5-12.
27. Yadav, K. N.,Gabler, N. B.,Cooney, E.,Kent, S.,Kim, J.,Herbst, N.,Mante, A.,Halpern, S. D.,Courtright, K. R.(2017).Approximately one in three US adults completes any type of advance directive for end-of-life care.Health Affairs,36(7),1244-1251.
28. Yen, W.-J.,Lundeen, S.(2006).The association between meaning of caregiving, perceived social support and level of depression of Taiwanese caregivers of mentally ill patients.The International Journal of Psychiatric Nursing Research,12(1),1378-1392.
29. Zimet, G. D.,Dahlem, N. W.,Zimet, S. G.,Farley, G. K.(1988).The multidimensional scale of perceived social support.Journal of Personality Assessment,52(1),30-41.
30. 內政部（無日期）．歷年簡易生命表平均餘命。2023年5月4日取自https://ws.moi.gov.tw/001/Upload/400/relfile/0/4405/48349492-6f8c-453b-a9d1-4a8f0593b979/year/y02-10.xls [Ministry of the Interior, Taiwan, ROC. (n.d.). Life expectancy by year. Retrieved May 4, 2023, from https://ws.moi.gov.tw/001/Upload/400/relfile/0/4405/48349492-6f8c-453b-a9d1-4a8f0593b979/year/y02-10.xls]
31. 內政部戶政司（無日期）．人口統計資料—年度縣市及全國統計資料。2022年6月11日取自https://www.ris.gov.tw/app/portal/346 [Department of Household Registration, Ministry of the Interior, Taiwan, ROC. (n.d.). Demographics - Annual county and national statistics. Retrieved June 11, 2022, from https://www.ris.gov.tw/app/portal/346]
32. 吳秀芳, H.-F.,蕭雅竹, Y.-C.(2009)。護理人員靈性健康與靈性照護能力之相關性研究。護理暨健康照護研究，5(1)，68-78。
33. 林昀蓁, Y.-C.(2018)。國立中山大學=National Sun Yat-Sen University。
34. 林慧美, H.-M.(2009)。國立臺灣大學=National Taiwan University。
35. 莊美幸, M.-H.,陳明正, M.-C.,復采蘋, T.-P.,謝明軒, M.-H.,劉嘉仁, C.-J.,翁林仲, L.-C.,黃勝堅, S.-J.(2021)。生命識能與哀傷教育。北市醫學雜誌，18(2)，149-154。
36. 陳偉熹, W.-H.,陳潔宜, C.-I.(2020)。末期醫療照顧替代決定之有效性：文獻回顧。醫療品質雜誌，14(4)，40-46。
37. 衛生福利部（無日期）．歷年簽署人數統計．預立醫療決定、安寧緩和醫療及器官捐贈意願資訊系統。2022年6月19日取自https://hpcod.mohw.gov.tw/HospWeb/RWD/Statistics/calc_report.aspx?year=2022 [Ministry of Health and Welfare, Taiwan, ROC. (n.d.). Statistics of signatories over the years. Advance Decision, Hospice Palliative Care and Organ Donation Intention Information System. Retrieved June 19, 2022, from https://hpcod.mohw.gov.tw/HospWeb/RWD/Statistics/calc_report.aspx?year=2022]
38. 衛生福利部統計處（2022，4月20日）．健康平均餘命指標資料表。[Department of Statistics, Ministry of Health and Welfare, Taiwan, ROC. (2022, April 20). Healthy average life expectancy index data table.] https://www.mohw.gov.tw/dl-77222-b656d2e0-ad05-49e9-89bf-b442c41484a1.html
39. 蕭雅竹, Y.-C.,黃松元, S.-Y.(2005)。靈性健康量表之建構及信、效度考驗－以護理學生為題。實證護理，1(3)，218-227。

1. (2024)。臨終醫療抉擇：民眾對簽署DNR聲明的認知、態度與意圖研究。管理實務與理論研究，18(2)，1-16。