從國內居家整合照護計畫探討安寧緩和整合照護模式新契機

A Study Investigating the New Opportunities for Hospice and Palliative Integrated Care Model of Home-based Integrated Care Program in Taiwan

10.6880/TJON.202106_21(1).01

施秀樺(Hsiu-Hua Shih)；黃采薇(Tsai-Wei Huang)

安寧緩和照護 ； 整合照護模式 ； 預立醫療照護諮商 ； Hospice Palliative Care ； Integrated Care Model ； Advance Care Planning

腫瘤護理雜誌

21卷1期（2021 / 06 / 01）

5 - 17

繁體中文

面對快速高齡化社會，加上癌症為台灣主要死因，健康照護、緩和照護與安寧照護的整合成為當前健康照護體系變革重要議題。不論是國內外的趨勢，提升癌症照顧的品質，很重要的一步是將安寧緩和醫療整合到癌症治療。而整合成功與否的品質指標，為個案過世前半年，接受安寧緩和照護的比率（安寧療護涵蓋率），政府目前推行「108年居家醫療照護整合計畫」將「個案死亡前6個月內安寧照護情形」列入監測指標，強調末期個案安寧緩和照護整合的重要性，而國外的緩和照護以跨專業團隊提供緩和照護定為居家個案的最佳模式，本文探討國內目前居家整合照護與國外緩和照護的差異，期望提供政府未來推動早期安寧緩和照護之參考。成功推展居家安寧緩和照護有賴於：（1）醫學中心出院準備服務與下游轉介醫師及獨立型態居家護理所建構垂直整合流程，銜接個案照護問題，加強連結中醫師、藥師專業訪視；（2）配合病人自主權利法上路，將預立醫療照護諮商（ACP）課程納入安寧照護繼續教育；（3）制定早期緩和照護訓練課程，及早協助末期個案安寧緩和照護計畫；（4）推動其他專科醫師參與安寧緩和照護團隊，藉以提昇末期個案及家屬接受安寧居家照護的可近性，返家持續得到照護達到在宅善終願望。

In the rapidly aging society where cancer is the main cause of death in Taiwan, the integration of healthcare, palliative care, and hospice care has become an important issue of current healthcare system revolution. Both the domestic and foreign tends are to improve cancer care quality. One of the important steps is to integrate hospice and palliative care with cancer treatment, and the key quality indicator for successful integration is the proportion of patients receiving hospice and palliative care (coverage of hospice care) in the 6 months prior to death. The government is currently promoting the ＂2019 Home-based Integrated Care Program＂ to include the ＂hospice care situation within 6 months prior to the death of patients＂ into the monitoring indicators. The Program emphasizes the importance of hospice and palliative integrated care of patients with end-stage cancer. The foreign palliative care uses interdisciplinary professional teams to provide palliative care as the best model for home-based care. This study investigates the difference between the current home-based integrated care in Taiwan and foreign palliative integrated care, in the hopes to provide the research results as reference for the government to promote early palliative care in the future. Successful promotion of home-based hospice and palliative integrated care is dependent upon: (1) medical centers' discharge preparation service and downstream referral physicians' and free-standing agency development of vertical integrated process, bridging patient care issues, and strengthening of professional visits by traditional Chinese medical practitioners, dentists, and pharmacists; (2) inclusion of the Advance Care Planning (ACP) courses into the hospice care continued education in line with the promulgation of the Patient Right to Autonomy Act; (3) development of early palliative care training courses and early hospice and palliative care program for assisting patients with end-stage cancer; (4) promotion of other specialists' participation in hospice and palliative care teams to improve the accessibility of home-based hospice care for patients with end-stage cancer and their family members and to enable them to continuously receive care at home and fulfill the wish of good death at home.

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