某離島醫院執行安寧共照之成效

The Effect of Hospice Combined Care in Islands Hospital

10.6537/TJHPC.2013.18(1).2

洪淑美(Shu-Mei Hung)；尹玓(Ti Yin)；陳婉君(Wan-Chun Chen)；劉淑皎(Shu-Chaio Liu)；釋德行；陳佳宏(Jia-Hong Chen)；李松青(Sung-Ching Li)；朱德明(Der-Ming Chu)

生命末期 ； 不施予心肺復甦術 ； 決策 ； 安寧療護 ； End of life ； DNR (do not resuscitate) ； Decision-Making ； Hospice care

安寧療護雜誌

18卷1期（2013 / 03 / 01）

14 - 23

繁體中文

研究目的：本研究以描述性方式分析2011年接受安寧共照服務之48位病人臨床資料。瞭解未來規劃團隊教育執行安寧療護策略擬定之參考。材料與方法：本研究樣本為2011年，離島內外科病房接受安寧共照服務之48位病人。利用Microsoft Access 97資料庫軟體設計病人資料。收集的資料包括；基本資料、轉入日期、診斷、是否轉移、症狀、簽署DNR、病情告知、心理、靈性與社會問題、出院狀況等，以SPSS For Windows 12.0版套裝統計軟體做基本描述分析。結果：住院病人診斷排名依序為肝癌、肺癌、直腸癌。常見轉移部位前三名；肝、肺及骨轉移。DNR 由未簽署54%至有簽署為84%；心理社會問題病人以情緒困擾41%最高，家屬48%，經濟資源支持系統缺乏40%，疾病認知與適應困難32%，而家屬46%，其兩者皆相較病人高。靈性宗教需求以存在的孤獨與隔絕感、對生命意義與價值的疑慮、對生命去向死後不確定性皆41%最高，面對死亡的疑慮與恐懼40%；住院時病人常見症狀以疼痛最高（100%），尤以腹部疼痛居多、虛弱疲倦（98%）、食慾不振（85%），及吞嚥困難（44%）。出院原因；尤以病情惡化，緊急出院回家往生最多，反映出離島當地人文化趨於傳統習俗，希望落地歸根，故本研究結果發現其離島應發展安寧居家服務之重要性，以強化與發揮離島安寧照護團隊角色功能，減少病人及家屬往返奔波，進而協助病人可在家渡過餘生，與維持家庭結構功能的完整性。結論：真相已知技巧是執行安寧共照很重要的議題。

Purpose: Hospice care is the best attendance way for cancer patients. In order to promote and increase the hospice care covering rate, the Department of Bureau of Health Promotion has launched a hospice combined care project since 2005. We have joined this project in our hospital locating at the islands since that time. The purpose of this study is to explore the impact of this project on the utilization of hospital-based hospice care and home hospice care at the local conditions. Material and Methods: The study subjects were terminal cancer patients who had underwent hospice combined cares in our hospital in 2011. Data collected included: basic information into the date of diagnosis, whether the transfer of the symptoms, signed the DNR, psychological, spiritual and social problems, discharge status. The statistical method of the study is performed by SPSS and Windows 12.0. Results: A retrospective analysis showed 48 cancer patients of terminal stage under the mode of hospice combined care during this period. The diagnostic ranking order is of liver cancer, lung cancer, and colorectal cancer. The top three sites of metastasis are liver, lung and bone. Psychosocial emotional distress, loneliness and sense of isolation, the meaning of life and the value of spiritual religion needs to exist doubts position life after the death of the uncertainty highest. Discharged reasons; especially deteriorated emergency discharged home most reflects islands locals Culture, tends to traditional practices, and the lack of truth telling. Conclusions: Our study suggested that Truth telling skills are important issues as Executive hospice.