住院病人對醫療預立指示知識、態度與行為意向之研究

Abstract

本研究目的在探討住院病人對醫療預立指示知識、態度與行為意向及其相關因素，採橫斷式相關性研究，以自擬結構式問卷為調查工具。自2008年12月至2009年4月，於台北某聯合醫院之五家區域等級院區之內外科病房之成年住院病人，有效樣本數為206人。 研究結果發現：1.本研究之住院病人在醫療預立指示知識方面總體得分偏低，較瞭解的部分為相關安寧緩和醫條例的定義與理念，而在相關醫療預立指示的法律條文規定顯得較不清楚。2.對於醫療預立指示態度傾向正向3.醫療預立指示行為意向方面，住院病人可能會簽署「預立選擇安寧緩和醫療意願書」排序第一；簽署醫療預立指示行為意向重要預測因子為「安寧緩和醫療態度」與「醫療預立指示態度」當前兩者態度愈正向，其醫療預立指示行為意向動機愈強。4.71.6%住院病人希望醫療預立指示在台灣推廣，並認為住院期間醫護人員能透主動說明、或透過宣導短片或是單張文宣，都在醫院推行醫療預立指示很好的方式。 結論：醫療預立指示觀念需要透過若透過有效的宣導方式，增加住院病人對於醫療預立指示的認識，影響對醫療預立指示態度，進而提升住院病人的意向與意願。

This study was conducted using a crossing-sectional research mothod.The purpose of this study was to discuss the knowledge, attitude and behavior intention of inpatients toward advance directives.The data was collected from designed structural questionnaire. From December 2008 to April 2009, 206 adult inpatients from the medical-surgical wards in five medical regional branch of united hospital in Taipei were included in the study. The results were as follows: (1)The inpatients scored low on knowledge of advance directives. Inpatients tended to know more about definition and concepts of palliative care but didn’t know clearly about the laws and regulations regarding advance directives. (2)Inpatients tended to have positive attitude towards advance directives. (3)Among the results of inpatients’ behavior intention to advance directives, the possibility of “signing consents to palliative care” ranked first; the two important predict factors for inpatients to sign “consents to advance directives” were “attitudes towards palliative care” and “attitudes towards advance directives”. If the two factors are more positive, the motivation for behavior intention of advance directives will be stronger. (4)71.6% of the inpatients are willing to see advance directives policy to be implemented in hospitals throughout Taiwan, and they agreed that information and notice voluntarily provided by medical professionals during in-hospital period as well as properly designed video or pamphlets are all good ways for the implementation of advance directives. The conclusion of this study was: the implementation of the advance directives policy requires more effective penetrations and educations to inpatients. The patient’s increasing knowledge and understanding of advance directives will positively influence their attitudes and consequently promote their behavior intention to give advance directives.