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題名：病人對預立醫囑的看法--以彰化某醫院家庭醫學科門診病人為例
書刊名：安寧療護
作者：張惠雯／顏啟華／林鵬展／劉立凡
作者(外文)：Chang, Hui-wen／Yen, Chi-hua／Lin, Peng-chan／Liu, Li-fan
出版日期：2011
卷期：16:3
頁次：頁296-311
主題關鍵詞：預立醫囑；預立醫療自主計畫；Advance directives；Advance care planning
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(7) 博士論文(1) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:7
  • 共同引用共同引用:0
  • 點閱點閱:50
研究目的：預立醫囑可讓患者在自己無能力決定生命末期醫療決策時，藉由書面聲明清楚指引家人及醫療團隊自己想要的醫療方式。為了解台灣病人對預立醫囑的看法，設計自擬式結構問卷。材料與方法：於彰化某醫院家庭醫學科門診收案，從民國99年9月07日至民國100年9月06日止，共計收案一年。以結構式問卷及社會支持量表、生活滿意度量表、憂鬱量表與意願進行交叉分析及統計推論。描述性統計進行各年齡層人口學變項資料分析，推論性統計以邏輯斯複迴歸分析意願相關影響因素。結果：預立醫囑意願單變項分析有意義的相關因素為憂鬱傾向、平均社會支持、生活滿意度、自覺健康、曾參與不急救同意書討論的相關經驗、了解疾病嚴重度及預後及死亡焦慮。經邏輯斯複迴歸分析顯示，希望了解疾病嚴重度及預後（OR = 5.376）及曾參與不急救同意書討論（OR = 2.124）的受試者有意願預立醫囑機會較高。死亡焦慮中「非常害怕」（OR =0.259）及自覺健康同齡比「很好」（OR = 0.280）的受試者有意願預立醫囑機會較低。預立醫囑的意願與社會人口學變項性別、婚姻狀況、居住型態、主要照顧者、主要醫療決定者、社會福利、私人醫療保險、宗教信仰及社會支持無相關。結論：醫護人員適時給予病人靈性支持降低死亡焦慮，引導病患及其家屬討論生命末期醫療決策，可以協助病人早期完成「預立醫療自主計畫」。
Background: The spirit of advance directives (AD) is respecting patient autonomy and to ensure what would be done if they lose the capacity to decide for themselves. Material and Method: We used a structured questionnaire to survey willingness of AD in outpatients of Department of Family Medicine in Changhua city from September 2010 to September 2011. We identified influencing factors of AD by conducting multivariate logistic regression analysis. Results: Significant factors from univariate analysis were depression status, social support, life satisfaction, perceived health status, having experience of discussing "Do Not Resuscitate", being aware of prognosis of disease and fear about death. Logistic regression analysis indicated that preference of AD positively associated with being aware of prognosis of disease (OR = 5.376 ) and having experience of discussing "Do Not Resuscitate" (OR = 2.124 ); negatively associated with severe fear about death (OR = 0.259 ) and perceived health status comparing with peers excellent (OR = 0.280 ). There was no significant relationship on preferences of advance directives between demographic characteristics, social support, depression status and life satisfaction. Conclusion: Medical staff members provide patients with spiritual support to decrease fear about death and raise issue of end-of-life care would facilitate the signing of 「Advance Care Planning」.
期刊論文
1.Fung, A. W. T.、Lam, L. C. W.、Lui, V. W. C.(2010)。Could hypothetical scenarios enhance understanding on decision for life-sustaining treatment in non-demented Chinese older persons?。Aging & Mental Health，14，994-999。  new window
2.Hu, W. Y.、Huang, C. H.、Chiu, T. Y.、Hung, S. H.、Peng, J. K.、Chen, C. Y.(2010)。Factors that influence the participation of healthcare professionals in advance care planning for patients with terminal cancer: a nationwide survey in Taiwan。Social Science & Medicine，70(11)，1701-1704。  new window
3.Tang, S. T.、Liu, T. W.、Tsai, C. M.、Wang, C. H.、Chang, G. C.、Liu, L. N.(2008)。Patient awareness of prognosis, patient-family caregiver congruence on referred place of death, and caregiving burden of family contribute to the quality of life for terminally ill cancer patients in Taiwan。Psychooncology，17(12)，1202-1209。  new window
4.Matsui, M.(2007)。Perspectives of elderly people on advance directives in Japan。J Nurs Scholarship，39(2)，172-176。  new window
5.Barrera, M. Jr.、Sandler, I. N.、Ramsay, T. B.(1981)。Preliminary development of a scale of social support: Studies on college students。American Journal of Community Psychology，9(4)，435-447。  new window
6.Sheikh, J. I.、Yesavage, J. A.(1986)。Geriatric Depression Scale(GDS) Recent Evidence and development of a shorter version。Clinical Gerontologist: The Journal of Aging and Mental Health，5(1/2)，165-173。  new window
7.Radloff, Lenore Sawyer(1977)。The CES-D Scale: A self-report depression scale for research in the general population。Applied Psychological Measurement，1(3)，385-401。  new window
8.Chien, C. P.、Cheng, T. A.(1985)。Depression in Taiwan: epidemiological survey utilizing CES-D。Seishin Shinkeigaku Zasshi，87(5)，335-338。  new window
9.Thorevska, N.、Tilluckdharry, L.、Tickoo, S.、Havasi, A.、Amoateng-Adjepong, Y.、Manthous, C. A.(2005)。Patients' understanding of advance directives and cardiopulmonary resuscitation。Journal of Critical Care，20(1)，26-34。  new window
學位論文
1.葉瓊蘭(1999)。自費安養機構老人社會支持與身體健康、憂鬱之相關性探討(碩士論文)。中山醫學院。  延伸查詢new window
2.陳亦暉(1995)。影響安養機構內老人生活滿意度的因素：以中部某榮民之家為例(碩士論文)。國立雲林科技大學。  延伸查詢new window
其他
1.Advance Directives Seminar Group, Centre for Bioethics, University of Toronto(1992)。Advance directives: are they an advance?。  new window
2.Wiener, L. ; Ballard, E. ; Brennan, T. ; Battles, H. ; Martinez, P. ; Pao, M.(2008)。How I wish to be remembered: the use of an advance care planning document in adolescent and young adult populations。  new window
3.楊嘉玲、陳慶餘、胡文郁(2008)。醫療預立指示。  延伸查詢new window
4.Jackson, J. M. ; Rolnick, S. J. ; Asche, S. E. ; Heinrich, R. L.(2009)。Knowledge, attitudes, and preferences regarding advance directives among patients of a managed care organization。  new window
5.Mold, J. W. ; Looney, S. W. ; Viviani, N. J. ; Quiggins, P. A.(1994)。Predicting the health-related values and preferences of geriatric patients。  new window
6.Stone, S. C. ; Abbott, J. ; McClung, C. D. ; Colwell, C. B. ; Eckstein, M. ; Lowenstein, S. R.(2009)。Paramedic knowledge, attitudes, and training in end-of-life care。  new window
7.Teno, J. M. ; Nelson, H. L. ; Lynn, J.(1994)。Advance care planning. Priorities for ethical and empirical research。  new window
8.Torke, A. M. ; Sachs, G. A. ; Helft, P. R.(2011)。Timing of do-not-resuscitate orders for hospitalized older adults who require a surrogate decision-maker。  new window
9.VandeCreek, L. ; Frankowski, D. ; Johnson, M.(1995)。Variables that predict interest in and the completion of living wills。  new window
10.Ai, A. L. ; Hopp, F. ; Shearer, M.(2006)。Getting affairs in order: influences of social support and religious coping on end-of-life planning among open-heart surgery patients。  new window
11.Akabayashi, A. ; Slingsby, B. T. ; Kai, I.(2003)。Perspectives on advance directives in Japanese society: A population-based questionnaire survey。  new window
12.Menon, A. S. ; Campbell, D. ; Ruskin, P. ; Hebel, J. R.(2000)。Depression, hopelessness, and the desire for life-saving treatments among elderly medically ill veterans。  new window
13.Huang, Y. C. ; Huang, S. J. ; Ko, W. J.(2009)。Going home to die from surgical intensive care units。  new window
14.Liu, J. M. ; Lin, W. C. ; Chen, Y. M.(1999)。The status of the do-not-resuscitate order in Chinese clinical trial patients in a cancer centre。  new window
15.Tang, S. T. ; Chen, C. C. ; Tang, W. R. ; Liu, T. W.(2010)。Determinants of patient-family caregiver congruence on preferred place of death in Taiwan。  new window
16.Tang, S. T. ; Liu, T. W. ; Lai, M. S. ; Liu, L. N. ; Chen, C. H.(2005)。Concordance of preferences for end-of-life care between terminally ill cancer patients and their family caregivers in Taiwan。  new window
17.Huang, Y. C. ; Huang, S. J. ; Ko, W. J.(2010)。Survey of do-not-resuscitate orders in surgical intensive care units。  new window
18.Lee, H. C. B. ; Chiu, H. F. K. ; Kwok, W. Y. ; Leung, C. M. ; Kwong, P. K. ; Chung, D. W. S.(1993)。Chinese elderly and the GDS short form: a preliminary study。  new window
19.Chan, A. C.(1996)。Clinical validation of the geriatric depression scale (GDS): Chinese version。  new window
20.Griep, R. H. ; Chor, D. ; Faerstein, E. ; Lopes, C.(2003)。Social support: scale test-retest reliability in the Pro-Health Study。  new window
21.Noroozi, A. ; Ghofranipour, F. ; Heydarnia, A. R. ; Nabipour, I. ; Shokravi, F. A.(2011)。Validity and reliability of the social support scale for exercise behavior in diabetic women。  new window
22.Gay, L. R. ; Mills, G. E. ; Airasian, P. W.(2006)。Selecting a sample。  new window
23.Boehmer, U. ; Clark. M. ; Sullivan, M.(2010)。Advance care planning by unmarried women of different sexual orientations: the importance of social support。  new window
 
 
 
 
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