預立醫療照護諮商之北市聯醫經驗

The Implementation of Advance Care Planning in Taipei City Hospital

10.6200/TCMJ.201910/SP_16.0003

劉靜女(Ching-Nu Liu)；蔡宗達(Zong-Dar Tsai)；林欣儀(Hsin-Yi Lin)；黃彥蓉(Yen-Rong Huang)；孫馥敏(Fu-Min Sun)；林素妃(Su-Fei Lin)；黃鳳嬌(Feng-Chiao Huang)；蘇俞安(Yu-An Su)；賴怡蓁(Yi-Chen Lai)；楊君宜(Chun-Yi Yang)

病人自主權利法 ； 預立醫療照護諮商 ； 預立醫療決定 ； 意願人 ； 預立醫囑 ； 末期照顧 ； 人口特質 ； 醫療委任代理人 ； 家庭關係 ； 決策 ； Patient Right to Autonomy Act ； advance care planning ； advance decision ； declarant ； advance directives ； end-of-life care ； characteristics ； health care agent ； family relationship ； decision making

北市醫學雜誌

16卷附冊（2019 / 10 / 31）

25 - 37

繁體中文

目的：探討參與預立醫療照顧意願人之特性、醫療照護決定之想法及關注議題，作為未來工作之建議。方法：本研究採次級資料分析法，檢視2019年1月至7月10日間參與ACP之1,007位意願人所表達之預立醫療意願和決定。結果：女性佔65.04%；60歲以上佔54.52%；一般身分佔93.45%。超過6成諮商動機為期待尊嚴善終及預作生命安排。8成5選擇不接受維持生命治療和人工營養及流體餵養。執行預立醫療決定後之照護及死亡地點超過3成選擇為醫院，逾4成意願人尚未決定或選擇交由親人、醫療委任人決定。結論：本文討論參與ACP意願人之特性、家庭關係對進行ACP之影響、指定醫療委任人之困境、選擇臨終照顧和死亡地點之影響因素、預立醫囑討論時機和促進參與ACP動機之策略等議題，並提出未來工作之建議。

Objectives: To better understand the characteristics of whom engages in advance care planning (ACP) and their decisions and concerns on ACP. Methods: Using secondary data analysis to examine the data of 1,007 participants who engaged in ACP in the Taipei City Hospital from January 2019 to July 10, 2019. Results: Among the participants, 65.04% of them were women, 54.52% were over 60 years old, and 93.45 were of general identity. The consultation motives of more than 60% of the participants were the expectation of a good death with dignity and life prearrangement. A total of 85% of the participant chose not to receive life-sustaining treatment and did not wish to receive artificial nutrition and hydration. For preference of location for the end-of-life care and death, more than 30% of participants chose to be cared and die in the hospital; more than 40% of the participants had not make a decision yet or preferred to let their relatives or health care agent (HCA) decides. Conclusions: We have identified the issues encountered in the implementation of ACP, such as the characteristics of the declarants, impact of family relationships on ACP, limitation of HCA appointments, factors influencing the choice of the location of end-of-life care and death, timing to initiate the discussion of ACP, and strategies to promote for participating in ACP. We also provide recommendations for future practice.