不施行心肺復甦術與接受自然死亡：影響決策的標題與說明

Do-Not-Resuscitate Order and Allow Natural Death: The Titles and Information Contents Related to Decision

10.6537/TJHPC.2015.20(1).1

鄭秦妮(Chyn-Ni Tang)；謝至鎠(Ying-Wei Wang)；王英偉(Jyh-Gang Hsieh)；范聖育(Sheng-Yu Fan)

心肺復甦術 ； 不施行心肺復甦術 ； 接受自然死亡 ； 生命末期照顧 ； 溝通 ； Cardiopulmonary Resuscitation (CPR) ； Do-Not-Resuscitate (DNR) ； Allow Natural Death (AND) ； End-of-Life Care ； Communication

安寧療護雜誌

20卷1期（2015 / 03 / 01）

1 - 12

繁體中文

研究目的：臨終時是否要接受心肺復甦術為一重要決定，會受到醫病溝通的影響。而強調接受自然死亡的名稱被許多國家採用。研究目的為探索：(1)對於臨終拒絕接受心肺復甦術的看法；(2)不同的標題與說明內容對於簽署機率的影響；(3)不同年紀、疾病階段、與親屬關係對簽署機率的影響。研究方法：招募608位志工，平均年紀為53.68歲(SD=16.55)。使用問卷調查，並設計臨床腳本，設計不同的標題、說明內容、年紀、疾病階段與親屬關係，在不同條件下的壓力感受與簽署機率。結果：64.39%認為應在健康時討論，97.67%願意參與討論，51.04%認為應由自己與家人共同決定。接受自然死亡標題的壓力感受小於不施行心肺復甦術(t=-7.49, p ＜ .001)；說明目的、傷害與可能成效的簽署機率大於僅說明末期疾病(F=4.31, p=.005)；病人年紀越大(F=80.74, p＜ .001)、末期疾病(F=157.51, p ＜ .001)的簽署機率越高。配偶與成年子女為最重要的決定家屬(F=410.72, p ＜ .001)。結論：在溝通上可強調接受自然死亡、善終好走，並提供足夠的資訊以協助病人與家屬進行臨終時是否要接受心肺復甦術的決策。

Purpose: Receiving cardiopulmonary resuscitation (CPR) when dying is an important decision, which are influenced by physician-patient communication. The aims of this study were to explore: (1) the opinions of Do-Not-Resuscitate (DNR), (2) the effect of different titles and information contents on DNR decision, and (3) the effects of different ages, disease stages, and relationships with patients on DNR decision. Methods: There were 608 participants and mean age was 53.68 (SD = 16.55). A survey with different scenarios was presented, including different titles, information contents, ages, disease stages, and relationships with patients. Results: 64.39% of the participants agreed to discuss when healthy, and 97.67% wanted to participate the discussion, and 51.04% would make decision with families. The stress feeling in allow natural death was less than DNR (t = -7.49, p ＜ .001); the probability of signing DNR was significantly higher in full information with consequences and effect than only terminal disease (F = 4.31, p = .005); as well as patients with older age (F = 80.74, p ＜ .001) and terminal stage (F = 157.51, p ＜ .001). In addition, spouse and children were the most important relatives when deciding (F = 410.72, p ＜ .001). Conclusions: addressing natural death and good dying, as well as providing sufficient information can help patients and families make the DNR decision.

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