臨終之處與其影響因素之探究

The place of death and its influencing factors

10.6537/TJHPC.201912_23(3).04

黃銘源(Ming-Yuan Huang)；林承霈(Cheng-Pei Lin)

死亡地點 ； 安寧緩和療護 ； 末期照護品質 ； 家 ； Place of death ； hospice palliative care ； quality of dying and death ； home

安寧療護雜誌

23卷3期（2019 / 12 / 01）

254 - 266

繁體中文

根據過往的研究，「家」是多數人所選擇的臨終之處。這樣的選擇不只是出現在台灣，也普遍存在世界其他的國家中。哪些因素會影響病人產生不同的偏好及選擇進而影響病人實際的臨終之處？了解病人與家屬對於臨終照護需求與立場之不同所產生的想法差異，亦可能在臨終照護過程中扮演重要角色，這些議題都值得深究。此外，不同的照護場所可能影響病人的生命末期與死亡品質，同時對醫療體系、家屬或照顧者也會有不同的要求與負擔，需要個別化的討論與安排病人的生命末期照護計畫以改善其生活品質。隨著病情進展，病人的偏好也可能會隨著時間而改變。目前老年化的人口結構下，護理之家或長照機構亦可能成為許多人的臨終之處。若能在這些地點培育安寧緩和醫療專業人員，提供機構住民足夠的安寧緩和醫療照護，將有助於減少病人在臨終之前被送回醫院，影響其死亡品質。

According to previous evidence, 'home' is considered the preferred place of death for the majority of people. This choice is not only presented in Taiwan but also a mainstream in other country around the world. Therefore, it could be valuable to identify the factors that influence patients' preferences and choices affecting their actual place of death. Meanwhile, the divergence between patients' and their relatives' thoughts and perspectives on the end of life care needs plays an important role in a patient's end of life care process. These issues are all worth for further study. In addition, different place of care might influence a patient's quality of end of life and dying, and so do the different levels of requirements from healthcare system, families and caregiver. An individualized discussion with the patients and their families for the patients' care plan is needed to improve their quality end of life. Furthermore, as patients' disease progress in this aging society, patients' preferences might change over time. As for future projection, the increasing number of people die at the care homes or nursing homes. Only if there is adequate palliative care provision to the care home residents by competent healthcare professionals in hospice and palliative care in those institutes, patients can die at where they used to live rather than being sent back to hospitals during their end of life, influencing their quality of death and dying.

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