健康成人參與預立醫療照護諮商之經驗

The Experiences of Healthy Adults Participating in Advance Care Planning

10.6224/JN.202410_71(5).06

范淑詒(Shu-Yi FAN)；高綺吟(Chi-Yin KAO)

健康成人 ； 預立醫療照護諮商 ； 預立醫療決定 ； 決策經驗 ； healthy adults ； advance care planning ； advance decision ； decision-making experiences

護理雜誌

71卷5期（2024 / 10 / 01）

36 - 45

繁體中文;英文

背景：自病人自主權利法通過後，進行預立醫療照護諮商、簽署預立醫療決定者多為健康成人，不同於過去研究多著重於罹患重大傷病者。目的：瞭解健康成人參與預立醫療照護諮商之經驗。方法：本研究採質性研究設計，於北、中、南三家醫院預立醫療照護諮商門診收案。以完成預立醫療照護諮商且未持有重大傷病卡、無身心科診斷、可清楚表達之健康成人為研究對象，藉半結構式訪談蒐集資料，以內容分析法進行資料分析。結果：共15位受訪者接受訪談，分析訪談內容後萃取出三大主題「埋下預立醫療照護的種子」、「極力確保生命晚期尊嚴」、「成就預立醫療照護之關鍵」。健康成人進行預立醫療照護諮商、簽署預立醫療決定受過去經驗、確保尊嚴自主的意念所驅動，個人決策歷程受家人想法、社會文化、制度等關係影響。結論／實務應用：健康成人進行預立醫療照護諮商、簽署預立醫療決定過程，諮商團隊除了協助知情，若能重視友善溝通氛圍之營造，更能確保健康成人醫療偏好與期待如實反映，促進所有與會者相互關懷、支持和理解。

Background: After enactment of the Patient Right to Autonomy Act in Taiwan, most of the individuals participating in advance care planning (ACP) and signing advance decisions (AD) have been healthy adults. This demographic is inadequately covered in the literature, in which related studies focus primarily on individuals with major illnesses. Purpose: This study was implemented to understand the experiences of healthy adults participating in ACP. Methods: A qualitative approach was taken and participants were recruited from ACP outpatient clinics in three hospitals in northern, central, and southern Taiwan. All of the participants were healthy adults who had completed the ACP process, did not have a major illness, had no psychiatric diagnoses, and could express themselves clearly. Data were collected via semi-structured interviews and analyzed using content analysis. Results: A total of 15 participants were interviewed, generating three major themes: "Establishing the foundations of ACP", "Preserving dignity in end-of-life care", and "Key elements for successful ACP". Their motivation to engage in ACP and sign the AD form was influenced by past experiences and a desire to maintain dignity and physical autonomy through the aging process. Their decision-making processes were influenced by family opinions, sociocultural factors, and systemic dynamics. Conclusions/Implications for Practice: During the ACP and AD signing process, the consulting team not only helps healthy adults successfully provide informed consent but also, by fostering a supportive communication environment, ensures medical preferences and expectations are accurately reflected, thus promoting mutual care, support, and understanding among all parties.