腫瘤病人的善終

The Good Dying of Patients with Tumor

10.3966/168395442017101703001

胡文郁(Wen-Yu Hu)；陳瑞儀(Sui-Yee Chan)

善終 ； 生活品質 ； 癌症病人 ； 居家照護 ； 預立醫療照護諮商 ； good death ； quality of life ； cancer patient ； home care ； advance care planning

腫瘤護理雜誌

17卷增訂刊（2017 / 10 / 01）

5 - 16

繁體中文

華人是追求「善終」的民族，腫瘤病人於生命末期時，病人、家屬和醫療團隊人員均期望病人能提高生活品質以達善終，臨終照護是癌症病人接受全程醫療照護最後也是最重要的一段照護，研究指出：癌症病人臨終前7天才接受安寧照護，因此，如何協助末期病人及早準備達到善終將是腫瘤安寧緩和醫療的重要目標。善終評量是評價生命末期照顧服務或措施的重要成效指標之一，但它是一個多元屬性的複雜概念，也由於其動態的本質，經常讓腫瘤醫療團隊人員在評量善終時，會面臨許多瓶頸與挑戰。故本文就腫瘤病人在「善終」或「臨終與死亡品質」常見的評量工具，進行評量工具目的、內容、對象與信／效度之檢視，進而討論評量腫瘤病人「臨終品質」的範圍，以及善終準備的適切時機與涵蓋內容，這些將可作為納入「預立醫療照護計畫（advance care planning）」的討論內容。藉由對善終指標的認識，提早評量腫瘤病人對善終的想法與需求，期能據以評析腫瘤病人的偏好，以提供符合腫瘤末期病人期待之優質末期照顧，並減少病人過世後，家屬的哀慟反應，終能生死兩相安。

Chinese people value and hope for a ＂Good Death＂. When a cancer patient is facing his/ her end of life, the medical team, patient and the family all expect to increase the quality of life towards a good death, in which case, the palliative care is the last but the most important care period where the cancer patient could be provided with the whole person holistic medicine. Studies showed that cancer patients receive palliative care generally 7 days before their death; thus, the most important goal of palliative care should be how to help the terminal patients achieve a good death. The measuring of good death is one of the most important outcome indicators to evaluate the end-of-life service or strategies provided; however, the complexity and diversity attributes and the dynamic nature of good death make the outcome assessment difficult and challenging for the medical team. The purpose of this article is to discuss the evaluationaa of good death that are currently used in the common literature. The aspects of discussion include purposes, contents, validity, reliability, range of rating in cancer patients' ＂end-of-life quality＂, and the appropriate time and contents of good death in preparation for ＂advance care directive planning＂. The knowledge of the good dying indicators can assist the medical professional in assessing the preferences and needs of the cancer patients early on in order to provide high quality end-of-life care and also to decrease the family grief.

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