Behavioral Intentions of Physicians towards Providing Artificial Nutrition and Hydration to Terminal Cancer Patients and Its Implications for Nursing Care

醫師提供癌末病人人工營養與水分之行為意向及護理照護之應用

10.6537/TJHPC.2012.17(1).1

柯莉珊(Li-Shan Ke)；陳炳仁(Ping-Jen Chen)；胡文郁(Wen-Yu Hu)；邱泰源(Tai-Yuan Chiu)

人工營養與水分 ； 醫師 ； 態度 ； 行為意向 ； 護理應用 ； artificial nutrition and hydration ； physician ； attitude ； behavioral intention ； nursing implications

安寧療護雜誌

17卷1期（2012 / 03 / 01）

1 - 17

英文

目的：探討醫師對提供癌末病人人工營養與水分的知識、態度、行為意向，並分析影響醫師行為意向之因素，以及提供護理照護之應用。材料與方法：對象為2005年4月至2006年4月於台北某醫學中心內輪調至一般外科之醫師，以自擬結構式問卷收集資料，共收案46人。結果：醫師對提供癌末病人人工營養與水分的知識偏低。態度方面，雖然醫師感受癌末病人使用人工營養與水分的缺點甚於優點；在行為意向方面，醫師仍傾向提供癌末病人人工營養與水分。病人之整體狀況和倫理接受度為影響醫師提供癌末病人人工營養與水分之重要因素（Adjusted R^2=0.342）。結論：醫師雖認為癌末病人整體狀況需納入考量，但也許無法做好全面性的評估。護理人員應嘗試了解影響醫師提供癌末病人人工營養與水分之決策因素，以協助醫師獲得更完善的資訊，並充分與病人和家屬討論，做適當的決策以符合病人需要。

Purpose: To explore knowledge, attitudes, and behavioral intentions of physicians, and to analyze the factors influencing physicians' behavioral intentions toward provision of artificial nutrition and hydration in terminal cancer patients. The implications for nursing care were also examined. Material and Method: A quantitative study was conducted in a medical center in Taiwan during April 2005 to April 2006. Forty-six physicians working rotations in general surgery wards were recruited. A structured questionnaire was administered to the enrolled physicians. Results: Physicians' knowledge of providing artificial nutrition and hydration to terminal cancer patients was insufficient. Although physicians considered artificial nutrition and hydration for terminal cancer patients as more of a burden than a benefit, their behavioral intentions were still to provide it. Overall patient condition should be taken into account in the provision of artificial nutrition and hydration, and ethical acceptability had a significant impact on the physicians' behavioral intentions (Adjusted R^2=0.342). Conclusion: Physicians are concerned with the overall condition of their terminal cancer patients but may not be performing a comprehensive assessment. Nurses should be aware of the factors influencing physicians' decisions about administering artificial nutrition and hydration for terminal cancer patients and should assist physicians in gathering comprehensive information to be discussed with patients and their family about making decisions appropriate to the needs of the patient.