推動社區安寧照護之初探

A Preliminary Finding of Implementing a Community-based Hospice Palliative Care Program

鍾佳玘(Chia-Chi Chung)；黃翠咪(Tsuei-Mi Huan)；謝明書(Ming-Shu Hsieh)；林秋慧(Chiu-Hui Lin)；林雪蓉(Sheue-Rong Lin)；史麗珠(Lai-Chu See)

社區安寧照護 ； 需求 ； 善終準備 ； 善終服務滿意度 ； community-based hospice palliative care ； needs ； preparation of good death ； satisfaction of good death service

若瑟醫護雜誌

11卷1期（2017 / 04 / 01）

30 - 44

繁體中文

背景及目的：本研究對新北市轄區內接受社區安寧照護之病人及其家屬的問卷作二手資料統計分析，研究成果作為推動社區安寧照護之參考。方法：採平均數、標準差、次數、百分比來描述人口學特性。採麥氏檢定比較病人及家屬的需求。身心靈狀況方面，每次評估的平均間隔天數在6-9天間，以折線圖表達個案在善終的前1 次評估(-1)至善終的前5 次評估(-5)之身心靈變化情形，並採用廣義線性估計式(generalized estimating equations,GEE)比較有無差異。採成對樣本t 檢定比較接受社區安寧照護時及過世時的善終指標評估分數有無差異。結果：總計收集有效問卷40 份（回收率54.1%），多數為癌症病人(72.5%)。62.5%簽署「不施行心肺復甦術同意書」及「不施行維生醫療同意書」、20.0%簽署「預立安寧緩和醫療暨維生醫療抉擇意願書」。需求方面，以支持與傾聽較多（病人50.0%，家屬66.7% ） ， 其次為協助病情認知的病情與預後（ 病人29.2%， 家屬45.8%）、協助心願達成（病人及家屬同為20.8%）。病人的身體、心靈及焦慮狀況愈到後期愈糟。善終準備大部份都有執行。病人的身體、心靈狀況，善終前1 次最嚴重。多數家屬滿意善終服務。結論：社區安寧照護是末期病人的另一選擇。末期病人及家屬的需求最多為：支持與傾聽、協助認知病情與預後但達成尚不足，是未來可加強部份。

Background and purpose: A questionnaire survey was given to those who received the service of community-based hospice palliative care program in New Taipei City. We conducted secondary data analysis in order to improve the program. Methods: Secondary data analysis was performed and descriptive statistics was mainly used. Mean, standard deviation, frequency, and percentage was used to describe the data. McNemar's test was made to compare the demands between the patient and their family members. Paired t-test was made to compare good death score on the date receiving the hospice program and the date near death. Line chart was made to display the change of the physical, psychological, and spiritual status for the last several months before death, and generalized estimating equations (GEE) was made to compare the physical, psychological, and spiritual status for the last several months before death. Results: Data of 40 patients (response rate 54.1%) who completed the service were used for this study. Cancer was the predominant disease (72.5%) among these patients. Two-third had signed the consent form of not resuscitating and not applying life-sustaining medical treatment, respectively, and only 20.0% had signed the form of hospice service in advance. Support and listening was needed most (patients 50.0%, family 66.7%), followed by explaining the disease status and prognosis (patients 29.2%, family 45.8%), assisting accomplishment of patients' wish (patients 20.8%, family 20.8%). Many items in preparation of good death was accomplished. Status of physical, emotion, spirit were worse before death. Most families were satisfied with the service. Conclusion: Community-based hospice palliative care is an option for terminally-ill patients. Support, listening, explaining the disease status and prognosis are the major needs but with low accomplishment.

1. Chiu, TY,Hu, WY,Chen, CY(2000).Prevalence and severity of symptoms in terminal cancer patients: a study in Taiwan.Support Care Cancer,8(4),311-313.
2. Steinhauser, KE,Clipp, EC,McNeilly, M,Christakis, NA,McIntyre, LM,Tulsky, JA(2000).In search of a good death: observations of patients, families, and providers.Ann Intern Med,132(10),825-832.
3. Tang, ST,McCorkle, R(2001).Determinants of place of death for terminal cancer patients.Cancer Invest,19(2),165-180.
4. Twisk, J.W.(2003).Applied longitudinal data analysis for epidemiology: a practical guide.Cambridge University Press.
5. World Health Organization: WHO definition of palliative care. 2014/06/18. Retrieved from http://www.who.int/cancer/palliative/definition/en
6. 吳庶深,沈麗靚,張利中(2005)。三位安寧病房宗教師之角色定位與照顧內容之質性研究。安寧療護雜誌，10(4)，334-344。
7. 洪淑美,尹玓,陳婉君,劉淑皎,釋德行,陳佳宏(2013)。某離島醫院執行安寧共照之成效。安寧療護雜誌，18(1)，14-23。
8. 陳慶餘,邱泰源,胡文郁,宗惇法師,黃鳳英,惠敏法師(2003)。臨床宗教師照顧對癌末病人善終指數之提昇。安寧療護雜誌，8(1)，13-27。
9. 曾韻如,邱泰源,胡文郁,程劭儀,姚建安,陳慶餘(2005)。老年癌末病人善終之評估。安寧療護雜誌，10(1)，13-23。
10. 黃惠美,郭碧照,胡中傑,謝玉玲,黃曉峰(2005)。台中某社區民眾之安寧療護知識及其影響因素。安寧療護雜誌，10(4)，371-383。
11. 新北市政府衛生局：將人生最後階段的療護延伸到家裡新北市社區安寧照護服務 7 月 1 日上路。2014/11/04。摘自http://www.health.ntpc.gov.tw/web66/_file/1459/upload/ehealth/10206/pages/index-01-01.html
12. 趙可式(1997)。臺灣癌症末期病患對善終意義的體認。護理雜誌，44(1)，48-55。

1. 楊秉鈞,楊佳莉,陳瑞泉,許良豪,莊迺傑,莊美幸,高睿晨,侯君穎(2019)。居家醫療個案接受安寧療護之相關因素。台灣家庭醫學雜誌，29(2)，80-89。