末期病人撤除維生醫療－某醫學中心之經驗

Withdrawal of Life-sustaining Treatment in Terminal Ill Patients: A 2-year Experience in a Medical Center

10.6537/TJHPC.2016.21(3).4

杜明勳(Ming-Shium Tu)；黃資雅(Tzu-Ya Huang)；陳如意(Ru-Yi Chen)；曾馨慧(Shin-Hui Tzeng)；鍾瑞美(Jui-Mei Chung)；林璊鸚(Many-Zng Lin)

撤除維生醫療 ； 無效醫療 ； 拔管 ； 安寧緩和醫療 ； 末期病人 ； withdrawal of life-sustaining treatment ； futile medical care ； extubation ； palliative care ； terminal ill patient

安寧療護雜誌

21卷3期（2016 / 11 / 01）

289 - 303

繁體中文

研究目的：本研究旨在分析某醫學中心撤除維生醫療之現況。材料與方法：以南部某醫學中心2014 年1 月至2015 年12 月符合末期會診安寧共照，撤除維生醫療之病人為對象，分析其過程及結果。結果：共82 個病人撤除維生醫療，男性53 位，女性29位，平均年齡68.9 ± 19.1 歲，病人疾病以腫瘤及胸腔疾病最多各20 位。主要會談家屬以男性50 人為多，與病人之關係以成年(孫)子女41 位最多。家庭親密度以經常與家人聯絡者較多共68 人。本研究中81 位由家屬簽署不施行心肺復甦術暨維生醫療同意書。家庭會議後，發現主治團隊有相關問題者有24 例，以要求六小時內完成撤除維生醫療者最多有20 位；77 位家屬有相關問題，以撤除後多久會死亡之類別最多，共47 位。撤除項目以呼吸器最多有74 位。撤除維生醫療後病人平均存活時間為 3.3 ± 7.5 日。病人與家屬親密度與家庭會議中家屬之提問內容無顯著相關；撤除維生醫療後存活時間長短與撤除後是否轉至其他病房有顯著相關(p ＜ 0.001)。

Purpose: To evaluate the characteristics of withdrawal of life-sustaining treatment in terminally ill patients in a medical center in southern Taiwan. Methods: We conducted a retrospective survey of terminal ill patients received hospice-shared care for withdrawal of life-sustaining treatment in a medical center from January 1, 2014 to December 31, 2015. The demographic characteristics, the background of medical staffing and family members, and the process of family conference and withdrawal of life-sustaining treatment were collected for analysis. Results: Overall, 82 patients (mean age 68.9 ± 19.1 years, 53 males (64.6%) and 29 females (35.4%)) were enrolled in this study. Regarding the main diagnosis, the first on the rank were malignancy (24.4%) and lung disease (24.4%). 50 males (61.7%) and 31 females (38.3%) (mean age 50.3 ± 12.4 years) were mainly interviewed by hospice-shared care nurse, including 23 spouses (28%), 41 grown children or grandchildren (50%), and 13 parents (15.9%). 68 patients (84.0%) had tight family cohesion. The consent for withdrawal of life-sustaining treatment was signed by the family members in 81 patients. One unconsciousness patient had no family. Family conference was held with the medical team, hospice shared care team, and the family. Associated problems from the medical team were found in 24 cases. 20 staffs asked to withdraw life-sustaining treatment in 6 hours. 77 families raised questions and most of them (47 families) were concerned about the time to death after withdrawal of life-sustaining treatment. 74 patients had ventilator withdrawn. The mean of time to death after withdrawal of life-sustaining treatment was 3.3 ± 7.5 days. The family cohesion was not associated with the questions that family raised in the family conference. The time to death was significantly longer in patients who transferred to other ward after withdrawal of life-sustaining treatment. Conclusion: More and more terminal ill patients received palliative care and withdrew life-sustaining treatment in recent years. Further study is needed to evaluate the factors that may have influences on withdrawal of life-sustaining treatment.

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