住院老人接受預立醫療照護計畫介入之成效－系統性文獻分析

The Effectiveness of Advance Care Planning for Hospitalized Elderly Patients: A Systematic Review

10.6537/TJHPC.2012.17(1).4

柯莉珊(Li-Shan Ke)；王筱珮(Shiao-Pei Wang)

預立醫療照護計畫 ； 住院老人 ； 預立醫療指示 ； advance care planning (ACP) ； hospitalized elderly ； advance directives (ADs)

安寧療護雜誌

17卷1期（2012 / 03 / 01）

48 - 61

繁體中文

研究目的：以系統性文獻回顧方式分析預立醫療照護計畫對於住院老人之成效。材料與方法：利用關鍵字和字串，搜尋截至2012年4月發表於華藝線上圖書館、CINAHL、Medline 和Cochrane library等資料庫之文章。結果：納入3篇文章，全部文章都包含由一位專業人員發起或主導預立醫療照護計畫，以及介入措施皆從住院追蹤至社區。統合3篇文章，顯示執行預立醫療照護計畫可以有效提升預立醫療指示（advance directives; ADs）的簽署和提高醫師尊重病人生前期望的醫療照護方式、增加滿意度，以及降低家屬的壓力、焦慮和憂鬱。結論：預立醫療照護計畫需要有位符合資格的專業人員來發起，與病人、家屬和醫師做持續的溝通互動，建議由護理人員擔任協調者（facilitator），以及應開始著手規劃訓練預立醫療照護計畫協調者之相關課程。此外，多數的結果指標著重在家屬或照顧者的感受，建議回歸以病人為中心之考量，畢竟預立醫療照護計畫的精神是希望病人的末期照護符合其期待和被尊重，最後達善終。

Purpose: To analyze effectiveness of ACP for the hospitalized elderly patients with systematic review. Material and Method: Adopting keywords and string to search articles published in Airiti library, CINAHL, Medline and the Cochrane library database before April 2012. Results: We find three articles all randomized controlled trial (RCT). All three articles contain one professional to initiate or led ACP process forward and follow up the patients from the hospital to the community. To summarize these three articles, the implementation of ACP can effectively enhance the advance directives (ADs) signed rate. Proportion of the dead patient's wishes followed by their physicians increased. Patient and family satisfaction of hospitalization rose. As well as the families' stress, anxiety and depression reduced. Conclusion: ACP is a process. It needs qualified professionals to initiate continuous interaction with patients, their families and physicians. We suggest that nursing staff as a facilitator, and started planning training ACP facilitator those of related programs. In addition, the majority of outcome indicators focus on the feelings of family members or caregivers. We think that the focus should return to the consideration of patient-centered. After all, the spirit of ACP is to hope the end of the patient's care meeting their expectations and respect, eventually reaching good death.