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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 陳彥元(Yen-Yuan Chen) | |
dc.contributor.author | Ping-Hsun Chang | en |
dc.contributor.author | 張炳勛 | zh_TW |
dc.date.accessioned | 2021-05-13T08:36:16Z | - |
dc.date.available | 2017-08-26 | |
dc.date.available | 2021-05-13T08:36:16Z | - |
dc.date.copyright | 2016-08-26 | |
dc.date.issued | 2016 | |
dc.date.submitted | 2016-08-17 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/3729 | - |
dc.description.abstract | 民國101年12月起,為鼓勵安寧緩和醫療及末期病人預立醫囑,台灣之全民健康保險增列「緩和醫療家庭諮詢費」。透過此一給付,家庭會議開始有正式之記錄。在末期或重症醫療情境中,醫病溝通時常不足。家庭會議做為溝通之重要手段雖已有共識,但在台灣,有關家庭會議之實證研究仍相當有限。
本研究為一回溯性觀察研究,收集台大醫院腫瘤科病房2014年12月至2015年11月申報緩和醫療家庭諮詢費之病患共248人,分析患者之人口學變項、疾病嚴重度、參與家庭會議之角色及人數、家庭會議內容,以及相關醫療處置等,以迴歸分析家庭會議中可能影響「不施行心肺復甦術」之決定的因子。 研究發現,在家庭會議後一週、二週、一個月及追蹤結束(2016/5/31)時,會顯著提高不施行心肺復甦術之決定的因子有:照會安寧緩和醫療團隊、會議時之ECOG分數較高、病情緩慢惡化中或病危、癌症有遠端轉移、淋巴球百分比較低、醫療團隊出席會議人數較多,和信仰佛、道教或民間信仰。而其中最重要且效果持久的因素是照會安寧緩和醫療團隊,其次則是會議時之ECOG。而年齡、性別、該次住院是否使用抗癌藥物、患者本人是否出席、會議中是否討論DNR相關議題等,與患者在上述四個時間點是否決定DNR沒有顯著的關聯性。會議前仍在使用抗生素、未婚離婚分居或喪偶等婚姻狀態,在家庭會議後的兩天內與DNR之決定有關。家庭會議中有若男性家屬出席可能也對DNR決定的速度有影響。患者本人的出席與否,則與性別、年齡、ECOG、參與會議的人數、男性親友出席會議,和會議中是討論DNR相關議題有關。 | zh_TW |
dc.description.abstract | Since Dec 2012, Taiwan's National Health Insurance started to cover palliative family conference, and formal meeting records were required for the payment package.
In critical or terminal diseases, the communication between patients, their families and medical teams are often insufficient. Family meetings serve an important role in medical communication. But only few empirical studies exist for the famliy meetings in Taiwan. This is a retrospective cohort study. All family meeting payment package records in a medical center in northen Taiwan were collected from Dec 2014 to Nov 2015. 248 patients and their medical records, including variables of demographic data, diseae severity, participants and the content of the family meetings, and relevant medical interventions, were included. Multivariate logistic regression was performed to identify the association of these factors and the designation of Do-Not-Resuscitate (DNR) decisions. The association was tested in 7 days, 14 days, 30 days after the family meeting, and on May 31, 2015. The result showed that consulting a palliative team, high ECOG score during the meeting, disease in progression or imminent dying, distant metastasis, low lymphocyte percentage, more medical personnel attending the meeting, and believing in Buddism, Daoism or Taiwanese Folk Religion, were signinificantly and positively assosicated with DNR dicisions. Age, gender, using anti-cancer medication, the patient's participation of the family meeting, and discussing about DNR during the meeting, showed no significant association. Taking antiiotics during the meeting and marital status were significant only within 2 days after a family meeting. Having male family members in the meeting also potentially influences the DNR decisions. We also analysed factors influencing a patient's participation of a family meeting. The significantly associated variables were: age, gender, ECOG, number of participants, having male family members in the meeting, and discussing about DNR in the meeting. | en |
dc.description.provenance | Made available in DSpace on 2021-05-13T08:36:16Z (GMT). No. of bitstreams: 1 ntu-105-R03457001-1.pdf: 11136547 bytes, checksum: bb14bcdb7166f2a7ad1515d69c7e29b3 (MD5) Previous issue date: 2016 | en |
dc.description.tableofcontents | 誌謝 1
中文摘要 2 ABSTRACT 3 目錄 5 圖片清單 9 表格清單 10 Chapter 1 緒論 13 1.1 研究背景與重要性 13 1.2 研究動機 16 1.3 研究目的 16 1.4 研究問題及假設 17 1.5 名詞界定 17 Chapter 2 文獻探討 18 2.1 重症患者醫病溝通的不足 18 2.2 家庭會議作為醫病溝通工具之重要性 18 2.3 重症或末期疾病患者之決定能力 19 2.4 不同族群、文化間對於疾病末期之態度 20 2.5 台灣地區民眾選擇不施行心肺復甦術之現況 22 2.6 疾病嚴重程度之指標 23 Chapter 3 研究方法 27 3.1 研究架構 27 3.2 研究工具 27 3.2.1 電子病歷系統與紙本病歷 27 3.2.2 疾病嚴重度指標 31 3.2.3 決定不施行心肺復甦術的時間點 34 3.3 研究設計 35 3.3.1 病患納入條件 35 3.3.2 病患排除條件 35 3.3.3 研究步驟 36 3.4 資料收集及分析方法 38 3.5 研究之倫理考量 41 Chapter 4 研究結果 42 4.1 目標族群之人口學與疾病特性 45 4.1.1 疾病嚴重度指標 46 4.1.2 家庭會議之出席狀況 47 4.1.3 家庭會議召開之時機 49 4.1.4 家庭會議召開之治療目標及是否討論DNR 51 4.2 家庭會議後DNR狀態之變化 53 4.2.1 家庭會議後一週,DNR之情形及病患分布 53 4.2.2 家庭會議後二週,DNR之情形及病患分布 55 4.2.3 家庭會議後一個月,DNR之情形及病患分布 56 4.2.4 追蹤結束時DNR情形及病患分布 58 4.3 緩和醫療家庭會議影響DNR決定之因子 60 4.3.1 家庭會議後一週,影響DNR的因素 61 4.3.2 家庭會議後二週,影響DNR的因素 62 4.3.3 家庭會議後一個月,影響DNR的因素 63 4.3.4 追蹤結束時影響DNR的因素 64 4.3.5 家庭會議中影響會議到DNR天數之因素 65 4.4 影響患者本人出席之因素 67 4.5 次族群分析 68 4.5.1 針對特定癌症分析之結果 68 4.5.2 針對有照會安寧團隊之患者分析之結果 71 4.5.3 針對家庭會議有討論DNR議題之患者分析之結果 72 4.5.4 針對治療目標包含安寧緩和醫療之家庭會議分析之結果 73 Chapter 5 討論 74 5.1 消失的家庭會議紀錄 76 5.2 腫瘤病房中緩和醫療家庭會議之特性 78 5.2.1 家庭會議召開時之疾病嚴重度 78 5.2.2 治療目標是否包含安寧照護之差異 79 5.2.3 家庭會議召開之時機 80 5.2.4 參與家庭會議之人員及人數 81 5.2.5 患者本人出席之比例 82 5.3 有無DNR患者之人口學與疾病差異 84 5.3.1 參與會議人員的差別 85 5.3.2 住院日數的差別 86 5.3.3 無顯著差異的變數 87 5.4 緩和醫療家庭會議影響DNR決定之因子討論 88 5.4.1 迴歸模式的比較與選擇 90 5.4.2 照會安寧緩和醫療團隊對DNR決策之影響 91 5.4.3 出席之家屬性別對DNR之影響 94 5.5 影響患者本人出席之因素 96 5.6 次族群分析結果討論 99 5.6.1 照會安寧團隊之患者 99 5.6.2 在家庭會議中有討論DNR相關議題之患者 100 5.6.3 家庭會議中治療目標包含安寧照護之患者 101 5.7 研究限制 103 Chapter 6 結論與建議 106 6.1 研究結論 106 6.2 未來展望及建議 107 Chapter 7 參考文獻 108 附件 i | |
dc.language.iso | zh-TW | |
dc.title | 緩和醫療家庭會議之內容與不施行心肺復甦術決定之關聯性 | zh_TW |
dc.title | The association between the content of palliative family conferences and do-not-resuscitate decisions | en |
dc.type | Thesis | |
dc.date.schoolyear | 104-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 吳造中(Chau-Chung Wu),邱泰源(Tai-Yuan Chiu),許駿(Chiun Hsu),蔡兆勳(Jaw-Shiun Tsai) | |
dc.subject.keyword | 家庭會議,不施行心肺復甦術,自主決定,末期疾病,緩和醫療,腫瘤,癌症, | zh_TW |
dc.subject.keyword | family conference,do-not-resuscitate,DNR,autonomy,terminal illness,palliative care,cancer, | en |
dc.relation.page | 117 | |
dc.identifier.doi | 10.6342/NTU201602863 | |
dc.rights.note | 同意授權(全球公開) | |
dc.date.accepted | 2016-08-17 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 醫學教育暨生醫倫理研究所 | zh_TW |
顯示於系所單位: | 醫學教育暨生醫倫理學科所 |
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