「預立醫療照護諮商」門診模式成效初探

The Practice and Prospect of Advance Care Planning Outpatient Clinic

10.6537/TJHPC.201906_23(2).04

蔡佩渝(Pei-Yu Tsai)；謝雅琪(Ya-Chi Hsieh)；鍾明成(Ming-Cheng Chung)；許正眉(Jeng-Mei Hsu)

預立醫療照護諮商 ； 門診 ； 移動式門診 ； advance care planning ； outpatient clinic ； mobile clinic

安寧療護雜誌

23卷2期（2019 / 06 / 01）

155 - 167

繁體中文

台灣於2015年底通過「病人自主權利法案」，由醫療機構提供的「預立醫療照護諮商Advance Care Planning, ACP｣及「預立醫療決定Advance Directive, AD｣是本法實施之重點。本院組成了包括醫師、護理師、臨床心理師、社工師及關懷師的跨專業ACP團隊，成立每周一次免費ACP門診，提供意願者以約診方式在獨立的空間進行預立醫療照護諮商。執行時間從105年6月至106年12月，觀察出諮商前良好的準備，有助於諮商問題聚焦及諮商過程的流暢。固定的門診時段，較容易掌握時間及人力，但是有限的診次也影響了ACP門診利用。ACP門診團隊雖然提供了全方位完整的評估及諮商品質，但須耗費相當高的時間及人力成本。未來可以透過專業人員多功能化的ACP教育訓練課程，及發展一致的紀錄格式和諮商流程，在精簡人力之餘也不影響諮商品質。只要有受過完整訓練的ACP團隊人員，ACP門診模式可以在不同規模的醫療機構施行，並以「移動式門診」的方式，推展至長照機構。

In Taiwan, ＂Patient Self-determination Act＂ was legislated in late 2015, pursuant to which the making of written Advance Directive (AD) as well as Advance Care Planning (ACP) by consulting with a medical facility is key to the practice. We organized a well-trained interdisciplinary team, including physicians, nurses, case managers, psychologists, social workers, and spiritual care workers, who would engage to provide AD/ACP consulting service. The consultation is complimentary, appointed weekly, taking place in an isolated environment. Our ACP clinic, since the launch in June 2016, has served 53 cases until December 2017, resulting in mostly positive responses from the clients. Our experience of the practice showed that the deliberated preparation of specific questions for the attendee would facilitate an efficient consulting process. We acknowledged that fixed sessions of the ACP clinic might be an easier way to time control and personnel arrangement, which, however, also indicated limited accessibility to the clients. Besides, provision of comprehensive examinations and the quality consultation with the ACP clinic has consumed a lot of time and manpower. Thus, in order to reduce staffing requirements and maintain consulting quality, we shall train the personnel to be multi-functional through a variety of ACP educational courses; moreover, the recording format and the operating procedure of consultation must be standardized. Here, we propose a novel model of ＂mobile clinic＂, with which the ACP service can be practiced by a completely well-trained ACP team within any medical facilities of different scales, even a long-term care institution.

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