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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 戴玉慈(Yu-Tzu Dai) | |
| dc.contributor.author | Shin-Ying Wang | en |
| dc.contributor.author | 王詩盈 | zh_TW |
| dc.date.accessioned | 2021-06-15T04:08:30Z | - |
| dc.date.available | 2011-03-12 | |
| dc.date.copyright | 2010-03-12 | |
| dc.date.issued | 2010 | |
| dc.date.submitted | 2010-02-04 | |
| dc.identifier.citation | 中文部份
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/45198 | - |
| dc.description.abstract | 尊重病人自主，係指有能力作決定的病人（competent patient）應享有權利，如決定及選擇自己期望的照顧方式，這是醫學倫理首要之原則。台灣自邁入老年國以來，老年族群日益龐大。隨著老化，個人罹病的機率增加也可能面對無可避免的生理衰退及功能受限，關於治療疾病的相關訊息及決策也隨之增加，但其意願卻常常被忽略；然而了解其意願及感受，方能提供適切的服務以滿足其需求。因此，本研究的目的在探討老人的醫療自主性意願（尋求醫療資訊、參與醫療決策）及其相關影響因素，採橫斷式相關性研究設計，以自主偏好指數（Autonomy Preference Index）為測量老人醫療自主性意願的工具，於2009年8月至2009年10月止，以立意取樣及面對面訪談的方式於台北市某醫學中心進行收案，有效樣本共98人。將所收集資料，以SPSS15.0版進行統計分析。
研究結果發現：（1）老人參與醫療決策自主偏好，於老人-醫師組合中自主偏好平均分為2.55分±0.52，傾向將決策權交由醫師或與醫師共同參與醫療決策；於老人-家屬組合，平均分為3.64分±0.69，偏好與家屬共同參與醫療決策或將醫療決策權由自己掌控。（2）老人對於尋求醫療訊息有高度偏好，平均得分為4.40分±0.68。（3）疾病嚴重度高時，老人參與醫療決策自主偏好程度低。（4）尋求醫療資訊偏好與參與醫療決策自主偏好呈正相關。（5）老人對於醫師的決策期待，最高之前二項為「分析決策利弊」及「提供有關決策的詳細資訊」，對於家屬的決策期待，最高之前二項為「陪伴」及「配合醫師的建議」。（6）老人參與醫療決策自主偏好在老人-醫師組合之重要預測因子為教育程度 / 沒有上學、教育程度 / 高中（職）、年齡 / 76-80歲，可解釋的變異量為13.68 %（p＜.001），老人參與醫療決策自主偏好在老人-家屬組合之重要預測因子為性別 / 男性、教育程度 / 沒有上學、年齡 / 76-80歲、經濟來源 / 非由子女供應、居住型態 / 獨居，可解釋的變異量為41 %（p＜.001）。老人尋求醫療資訊偏好之重要預測因子為經濟來源 / 非由子女供應、教育程度 / 沒有上學、居住型態 / 獨居，可解釋的變異量為24.7%（p＜.001）。 本研究發現，提供適合且可理解的醫療資訊有助老人主動參與醫療決策，作者建議醫護人員應於照護過程中了解老人的特性及意願，協助老人瞭解資訊及鼓勵表達意願，促進醫療人員、老人、家屬之間之有效溝通，以維護老人的醫療自主權。 | zh_TW |
| dc.description.abstract | Respect for patient autonomy is a primary principle of bioethics and means the right of competent patients to determine their own health issues. With the rapid aging of the Taiwan population, an ever increasing number of elderly confront morbidity and physical decline and limited physical function. Although the demand for relevant information to make informed decisions about treatments is increasing, the preferences and needs of the elderly are often neglected. Understanding the preferences and perceptions of the elderly is the basis for providing appropriate and satisfactory care. The aim of this study, therefore, was to investigate the preferences for autonomy in seeking medical information, participation in medical decision-making and related factors in the elderly population of Taiwan. A cross-sectional study was designed and 98 cases were collected in a medical center in northern Taiwan from August 2009 to October 2009. This study was conducted by purposive sampling and face-to-face interview using the Autonomy Preference Index (API) to measure elderly medical autonomy. Data was analyzed using SPSS software version 15.0.
The results showed that: (1) elderly participation in medical decision-making autonomy preferences of the “elderly - doctor combination” (mean score 2.55 ± 0.52), which means that the elderly tend to collaborate or give the decision to a physician; and the “elderly - family combination” (mean score was 3.64 ± 0.69), which means the elderly prefer to make decisions in collaboration with family or make decision by their own; (2) the elderly have a high intention to seek medical information (mean score 4.40 ± 0.68); (3) the elderly prefer a greater degree of autonomy when faced with making a medical decision about a more serious disease; (4) there is a positive correlation between the preference for information seeking and preference for medical decision-making; (5) among the expectations of the elderly when make a decision, the top two items that elderly expected from a physician were “analysis of the pros and cons” and “ provide detailed information”, and the top two items that the elderly expected family were “accompanying” and “following the recommendation of the physician”; (6) uneducated, high school education, and being aged 76 to 80 years old were predictors of the elderly participation in medical decision – making autonomy preferences for the elderly - doctor combination, the explainable variance is 13.68% (P < .001). Being male, uneducated, aged 76 to 80 years old, not being supported by children, and living alone were predictors of elderly participation in medical decision-making autonomy preferences for the elderly – family combination, the explainable variance is 41% (P < .001). Not being supported by children, uneducated and living alone were predictors of the elderly seeking medical information preferences, the explainable variance is 24.7% (P < .001). According to these results, providing appropriate and comprehensible medical information may increase the willingness of elder people to participate in the medical decision making. Moreover, in order to improve the communication between medical staff, the elderly and family members, and maintain the decision-making right of elderly, medical staff need to understand the characteristics and willingness of elderly patients and assist them in obtaining medical information or self-expression. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-15T04:08:30Z (GMT). No. of bitstreams: 1 ntu-99-R96426014-1.pdf: 1888771 bytes, checksum: 200cfb105ba92c715446d5bd9bc8cc72 (MD5) Previous issue date: 2010 | en |
| dc.description.tableofcontents | 口試委員審定書 i
致謝 ii 中文摘要 iii Abstract v 第一章 緒論 1 第一節 研究動機及重要性 1 第二節 研究目的 5 第三節 研究問題 6 第四節 名詞界定 7 第二章 文獻查證 8 第一節 醫療自主性的基本概念及意義探討 8 第二節 尋求醫療資訊與參與醫療決策及其相關研究 12 第三節 老人對醫師及家屬於醫療決策時的決策期待 16 第四節 影響老人醫療自主性意願的相關因素 18 第三章 研究方法 23 第一節 研究架構 23 第二節 研究假設 24 第三節 研究設計 25 第四節 研究場所、對象及檢力分析 26 第五節 研究工具 27 第六節 研究工具的信效度檢定 31 第七節 資料收集流程 33 第八節 資料分析 34 第九節 研究倫理考量 35 第肆章 研究結果 36 第一節 個案的基本屬性及疾病嚴重度對醫療自主性意願的現況 分析 37 第二節 個案對於家屬和醫師的決策期待 41 第三節 個案基本屬性及疾病嚴重度與醫療自主性意願的相關性 43 第四節 影響老人醫療自主性意願之重要預測因子 47 第伍章 討論 51 第一節 參與醫療決策自主偏好及尋求醫療資訊偏好程度 51 第二節 老人對家屬和醫師的醫療決策期待 55 第三節 影響老人醫療自主性意願之重要相關因素 57 第陸章 結論與建議 61 第一節 結論 61 第二節 護理應用 64 第三節 研究限制及未來研究之建議 65 參考文獻 66 中文部份 66 英文部分 68 表目錄 表1 個案之基本屬性 74 表2 個案對參與醫療決策自主偏好程度（老人-醫師組合） 76 表3 個案對參與醫療決策自主偏好程度（老人-家屬組合） 77 表4 不同疾病嚴重度之參與決策程度（模擬病況） 78 表5 個案對尋求醫療資訊偏好程度 79 表6 個案對於醫師和家屬的決策期待 80 表7 個案基本屬性與參與醫療決策自主偏好程度的關係（老人-醫師組合） 81 表8 個案基本屬性與參與醫療決策自主偏好程度的關係（老人-家屬組合） 83 表9 不同疾病嚴重度對個案參與醫療決策自主偏好程度的影響 85 表10 個案基本屬性與尋求醫療資訊偏好程度的關係 86 表11 尋求醫療資訊偏好與參與醫療決策自主偏好的相關 88 表12 影響個案參與醫療決策自主偏好之重要預測因子（老人-醫師 組合） 89 表13 影響個案參與醫療決策自主偏好之重要預測因子（老人-家屬 組合）90 表14 影響個案尋求醫療資訊偏好之重要預測因子 91 表15 各國研究者使用API測量尋求資訊及參與決策偏好之研究結 果92 附錄 附錄一 Professor Jack. Ende同意授權原版API之e-mail紀錄 93 附錄二 Professor Chang同意授權韓文翻譯英文版API之e-mail 紀錄 94 附錄三 Chang等人（2008）修改Ende等人1989發展的自主偏好指標95 附錄四 專家建議之問卷效度修改內容 98 附錄五 問卷效度測試之專家名單 99 附錄六 老人的醫療自主性意願及相關影響因素之結構式問卷 100 附錄七 整合「老人-醫師、老人-家屬組合」疾病嚴重度（模擬病 況）部分，便於實際訪談紀錄之問卷 110 附錄八 倫理委員會審查通過函 113 | |
| dc.language.iso | zh-TW | |
| dc.subject | 參與醫療決策 | zh_TW |
| dc.subject | 尋求醫療資訊 | zh_TW |
| dc.subject | 老人 | zh_TW |
| dc.subject | 醫療自主性 | zh_TW |
| dc.subject | seeking medical information | en |
| dc.subject | elderly | en |
| dc.subject | medical autonomy | en |
| dc.subject | participation in medical decision-making | en |
| dc.title | 老人的醫療自主性意願及其相關影響因素探討 | zh_TW |
| dc.title | Study of the Elderly Taiwanese Patient’s Medical
Autonomy and the Relating Factors | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 98-1 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 胡文郁(Wen-Yu Hu),吳彥雯(Yen-Wen Wu) | |
| dc.subject.keyword | 老人,醫療自主性,參與醫療決策,尋求醫療資訊, | zh_TW |
| dc.subject.keyword | elderly,medical autonomy,seeking medical information,participation in medical decision-making, | en |
| dc.relation.page | 115 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2010-02-05 | |
| dc.contributor.author-college | 醫學院 | zh_TW |
| dc.contributor.author-dept | 護理學研究所 | zh_TW |
| 顯示於系所單位： | 護理學系所 | |
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| 檔案 | 大小 | 格式 | |
|---|---|---|---|
| ntu-99-1.pdf 未授權公開取用 | 1.84 MB | Adobe PDF |
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