提升「死亡識能」－推廣在宅善終的高價值照護

Promoting Death Literacy - A High Value Health Care for Good Death at Home

10.6200/TCMJ.2017.14.3.01

黃喬煜(Chiao-Yu Huang)；徐愫萱(Su-Hsuan Hsu)；孫文榮(Wen-Jung, Sun)；李易翰(Yi-Han Lee)；翁瑞萱(Ruey-Shiuan Ueng)；吳孟嬪(Meng-Ping Wu)；施至遠(Chih-Yuan Shih)；黃勝堅(Sheng-Jean Huang)

死亡識能 ； 在宅善終 ； 居家照護 ； 安寧緩和 ； 末期照護 ； Death literacy ； Good death at home ； Home care ； Hospice and palliative ； End-of-life care

北市醫學雜誌

14卷3期（2017 / 09 / 30）

269 - 278

繁體中文

隨著安寧緩和概念的推廣，追求「在宅善終」成為現今高價值照護的目標，提升群體的「死亡識能(death literacy)」是達成此目標的核心。由健康識能延伸，「死亡識能」代表獲取、理解及使用末期照護相關資訊時的知識和能力；也可視為陪伴及照顧瀕死者、學習生死議題的人生智慧。死亡識能可分為四個面向，分別是知識(knowledge)、技能(skill)、經驗式學習(experiential learning)和社會行動(social action)。死亡識能的培養不僅依靠傳統式的教育，且須依靠照顧經驗的累積，醫療照護團隊實際走入病人家中，提供病人在宅末期照護，陪伴著家庭由生到死的關懷；家庭照顧者與醫療團隊合作，實際在宅照顧病人；透過居家照護的社區參與及在地善終的個案累積，整體社區一同培養死亡識能，才能真正推動以健康促進為導向的緩和照護(Health Promoting Palliative Care)。

With the promotion of the hospice and palliative care, good death at home has now become one of the core concept of high-value healthcare. Developing death literacy is one of the best way to achieve this goal. Death literacy means the capacity to obtain, understand and process information related to end-of-life care. Death literacy has four important dimensions: knowledge, skill, experiential learning, and social action. The development of death literacy relies not on traditional education, but also on the accumulation of experience of end-of-life care. Health professionals develop their death literacy when they provide home care at patient's home and accompany the family in the life to death process. Family caregivers develop their death literacy when they cooperate with medical teams and care the dying patient at home. Only when death literacy is cultivated in the whole community that the health promoting palliative care may be pushed forward.