Difference of Perception in Assessment of End-of-life Stage between Physicians and Nurses

醫護人員對於生命末期評估認知差異研究分析

10.6200/TCMJ.202409_21(3).0002

Ya-Chen Lin(林雅真)；Chih-Chien Cheng(鄭志堅)；Ann-Chi Shyur(徐安齊)；Li-Yun Fann(范立筠)；Yi-Chang Chou(周奕彰)；Chuan-Yi Chou(周全益)；Chung-Yeh Deng(鄧宗業)

palliative care ； assessment ； discordancy and disagreement ； accuracy ； 安寧照護 ； 生命末期評估 ； 認知差異 ； 準確性

北市醫學雜誌

21卷3期（2024 / 09 / 30）

224 - 234

英文;繁體中文

Objective: Timely initiation of end-of-life care for patients with life-threatening illnesses has proven to significantly improve their quality of life, allowing adjustments in treatment and preparation of patients and their families. However, identifying patients in need of palliative care is a challenge, as physicians and nurses may not always share the same perspectives. This study aimed to determine the differences between physicians and nurses in identifying patients needing palliative care and the factors influencing their perceptions. Methods: This retrospective study used the Taiwan palliative care screening tool (TW-PCST) to assess if the patients needed palliative care. McNemar test and Kappa analysis were used for statistical analyses. Multiple logistic regressions were used to identify factors affecting the perception of the end-of-life stage of the patients between physicians and nurses. Results: Complete assessments from physicians and nurses on 820 patients with potential end-of-life stage were collected. Total agreement between physicians and nurses was observed in 49% of the patients. Multivariate analysis revealed that senior nurses and physicians who received hospice care training had significantly higher agreement. Conclusion: Diverse viewpoints between physicians and nurses may cause the difference in whether a patient is approaching the end-of-life stage. The care team may reach an agreement through the discussion of expired cases. A reassessment for the end-of-life stage can be conducted when the critical conditions alter, and the critical conditions are informed earlier to improve the quality of end-of-life care. Besides, training courses should be held regularly, and junior physicians should be encouraged to join to improve the quality of end-of-life care.

目的：面對危急的重症疾病病人，及時啟動臨終關懷已被證明可顯著改善生活品質，並讓病人及其家人在面對生命的最後階段時做好準備。然而，識別病人生命末期評量是個挑戰，因為醫護人員可能觀點不同。因此本研究旨在確定醫護人員在識別需要安寧照護的病人的差異分析及影響看法的因素。方法：這是一項回顧性橫斷式研究，分析使用台灣版安寧療護篩檢工具（TW-PCST）評估病人是否有安寧治療需求，統計以McNemar檢定、Kappa測量，並以複邏輯斯迴歸方程式，分析不同職類醫護人員之間對於病人生命末期之認知差異的相關因子。結果：研究期間共820位潛在生命末期病人，收集完整的醫師和護理師對病人的評估報告。其中49%的病人在醫護之間意見完全一致。多變項分析發現，受過安寧訓練課程的資深護理師和資深醫師，會有顯著較高的意見一致性。結論：護理師和醫師對於病人是否接近生命末期的評估意見不同，可能肇因於不同觀點。團隊可透過死亡案例討論以達共識。當病人病情變化時，可依評量表再次進行末期評估，提前進行病情告知，提升末期階段高品質的照護。此外，醫療機構應定期辦理教育訓練課程，尤應鼓勵年輕醫師多參與，以提升生命末期病人照護品質。

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