生命末期醫療決策：訊息框架之研究

Abstract

近來，病人在生命末期醫療決策上的自主權備受重視，除現行之《安寧緩和醫療條例》之外，《病人自主權利法》亦已三讀通過，強調讓社會大眾在身體健康時，預先了解個人醫療權益，以思考自己在生命末期所期望的醫療照護模式，並透過文件的簽署掌握個人醫療自主權，以實踐善終。其中，訊息內容為推廣的核心，會影響個人的行為意圖，故本研究以生命末期醫療決策為主題，進行訊息元素傳播效果之測量，以了解如何適切地向個人（不同年齡層之青壯族）傳遞訊息，避免其不信任訊息（訊息減損），以增加議題被觸及與接受的機會。 本研究採用線上實驗法，為一單因子實驗設計，以訊息框架為操弄變項，訊息減損程度與年齡為調節變項，是否有面對死亡經驗為共變項，傳播效果（訊息態度、議題態度、行為意圖）為依變項。研究對象鎖定20至49歲之青壯族，且具閱讀能力及完全行為能力者（符合臺灣現行意願書規定之簽署條件）；研究參與者被隨機分至不同實驗組別。本研究共計回收469份問卷，有效樣本453份（完整填答率為96.5%）。 研究結果顯示，當生命末期醫療決策議題無論有無套用訊息框架，其傳播效果皆無顯著差異，而訊息減損程度、年齡及部份人口變項（健康狀態、經驗）則會影響訊息的傳播效果；其中，有接觸或與他人討論過生命末期醫療決策議題者，會簽屬意願書的機率約是沒接觸者的二至三倍之間。作為與民眾接觸的開端，訊息呈現、推廣方式可以如何使民眾感知到拒絕急救、接受安寧緩和醫療等決策之意義與價值？本研究結果可提供相關議題之推廣策略參考，並望能促使更多研究者以生命末期醫療決策為主題進行不同面向之研究，以有效進行議題傳遞，確保更多社會大眾能夠實踐自主權，保障自己的善終。

In addition to the existing “Hospice Palliative Care Act”,“ The Patient Autonomy Act” has been undergone the Third Reading, emphasizing the importance of giving people the chances to self-determination on end-of-life decision when healthy by signing the documents to master personal medical autonomy with the fully understanding of individual medical rights. Above all, message content is the core of the promotion process, which will affect individuals’ behaviors intention a lot. Therefore, this study measured the communication effects of message components to clarify the best way to communicate to individuals (young people between the ages of 20-49), to avoid message derogation, and making this issue being reached and well accepted. The online experiment was designed as a one-factor experiment, with message framing as manipulative variable, degree of message derogation and age as moderator variables, whether there was death experience as covariant variables, communication effect (message attitude, issue attitude, behavior intention) as dependent variables. The study participants were focused on young people between the ages of 20-49 with reading ability and full capacity (in accordance with the current conditions of Taiwan's law), and were randomly assigned to different experimental groups. A total of 469 questionnaires were collected, and there were 453 valid samples (96.5% of complete responses). The results of the study showed that there was no significant difference in the communication effects on different message framing, but the age, degree of message derogation and some demographic variables (health status, experience) affected the communication effects. What's more, the person who have contacted or discussed with other people in related issues are two to three times more willing to sign the “Advance Hospice Palliative Care and Life-Sustaining Treatment Choices of Intent” than ones who did not know the issue. As the initial hub with the public, how to make people perceive the importance and value of end-of-life decision by presenting and promoting information in more efficient way? The results hope to provide a reference for the promotion strategy of relevant topics, enable more researchers to contribute more about end-of-life decision area and so as to empower the public to better known the issue of their own rights of good death.