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http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/47604完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 陳端容 | |
| dc.contributor.author | Hou-Tai Chang | en |
| dc.contributor.author | 張厚台 | zh_TW |
| dc.date.accessioned | 2021-06-15T06:08:12Z | - |
| dc.date.available | 2011-07-01 | |
| dc.date.copyright | 2010-09-13 | |
| dc.date.issued | 2010 | |
| dc.date.submitted | 2010-08-14 | |
| dc.identifier.citation | A Meguid El Nahas and Bello, Aminu K (2005), 'Chronic kidney disease: the global challenge', Lancet, 365, 331–40.
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/47604 | - |
| dc.description.abstract | 末期腎病須要慢性透析的病人族群的增加已成為全世界健康照護系統的挑戰, 除了預防腎功能的變化導致透析, 避免不必要、無效的透析治療更是重要的議題。尤其是重症的慢性透析病患何時該建議退出透析, 這方面的文獻資料闕如, 所以我們的研究主要在了解影響醫師同意撤除透析的相關因子。
我們設計了一分情境式問卷, 模擬一個老年失智的慢性透析病例會面臨的五個臨床情境,以滾雪球模式發放了275分問卷給具照顧慢性腎病病例經驗的醫師。針對問卷中的五個情境各敘述了十個問題, 將醫師對各個情境最終的同意情形對醫師的基本變項資料做卡方檢定, 再將情境中各構面問題的同意程度做邏輯式迴歸, 以p<0.05 表統計學顯著相關。 249名醫師完成了問卷, 其中有效的問卷為240分, 回收率90.5%, 針對情境一描述老年失智的慢性透析患者, 僅14%的填答醫師同意在情境一建議退出透析,醫師同意建議撤除透析的比例在情境三當家屬也同意撤除透析時最高, 達86.4% 。在不同的病人情境下, 影響醫師同意終止透析建議的基本資料變項不同, 包括: 工作所屬醫院在北部(情境一、四)、工作性質為住院醫師(情境三、四) 、執業科別為胸腔暨重症科(情境三) 、主要工作地點在加護病房(情境四)、過去一年內曾有建議退出透析的經驗(情境三至五) 及醫師性別為女性皆會顯著增加同意退出透析的機會。邏輯式迴歸分析顯示, 醫師的專業判斷及病人年紀對醫師決策終止透析影響最大。醫師的基本資料變項亦會影響醫師在不同情境考慮的構面因素,影響程度不一。顯示醫師的決策是否同意提出終止透析的建議,隨著醫師的背景資料及病患的情境而定, 是一個動態的過程。 本研究發現醫師的決策過程隨病患不同的病況情境而變化, 影響因子也隨之改變, 所以根據本研究發現的影響因子, 建議進一步做相關的教育計劃, 訓練年輕醫師針對不同病患情境, 何時可考慮退出透析及相關考慮因素, 以對末期腎病的重病病患達更好的末期生命照護。 | zh_TW |
| dc.description.abstract | Background: The increasing prevalence of end stage renal failure patients is challenging in health care system around the world. In addition to prevention of the dialysis initiation, it is important in dialysis withdrawal if proven futile. Few data is available about factors associated with proposal of dialysis withdrawal for critically-ill ESRD patients. We therefore studied physician’s views and factors influencing physician’s decision-making on dialysis withdrwal.
Methods: We surveyed 275 physicians who were experienced in care of ESRD patients about their views on dialysis withdrawal. One hypothetical case with five clinical scenarios was included. Participants score their responses according Likert scale as a report to agree/disagree with the 10 statement within each scenarios. Participants’ demographic data were recorded. The correlation of demographic data to agreement of each scenario was calculated with chi-square test. The association of agreement to each statement was calculated with logistic regression method. It is statistically significant when p<0.05. Results : Of 275 physicians, 249 completed surveys and 240 effectively returned . Fourteen percent of physicians agreed to withdraw dialysis in scenario one when clinical information of the hypothetical ESRD patient with old age and dementia. Highest agreement ( 86.4%) was achieved in scenario three when families responded agreement to dialysis withdrawal. There are different demographic factors associated with dialysis withdrawal proposal in each scenario are hospital at northern Taiwan (scenario 1,4)、level of training(Scenario 3,4)、subspecialty(scenario 3)、ICU full-time physician(scenario 4)、experience of proposal of dialysis withdrawal in the preceeding year(scenario 3-5) and gender (scenario 5). Logistic regression result showed physician experts ( his/her own opinion) possessed the most important consideration (odds ratio: 2.908, 2.617, 2.970, 2.809, p<0.01) associated with dialysis withdrawal proposal in four scenario (scenario 1,2,3,5). Age factor also affected dialysis withdrawal decision-making (odds ratio: 2.294, 2.085, 3.200, 1.862, p<0.01) in four scenario( scenario 1-4). The significance of associated factors in dialysis withdrawal was modified in different extents after adjusted with demographic background. It represents that the decision-making in dialysis withdrawal is a dynamic process, which is influenced by physician’s personal characteristics. Conclusion: Physicians exert different thinking process according to different clinical scenarios. Our study identified factors associated with dialysis withdrawal decision-making process. Further education program will be indicated for junior doctors about timing and consideration in dialysis withdrawal to achieve optimal end-of-life care in critically-ill ESRD patietns. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-15T06:08:12Z (GMT). No. of bitstreams: 1 ntu-99-P96843006-1.pdf: 566628 bytes, checksum: 0486514e3508cc078f0d37903b3a0a66 (MD5) Previous issue date: 2010 | en |
| dc.description.tableofcontents | 口試委員會審定書 i
謝辭 ii 中文摘要 iv 英文摘要 v 第一章 緒論 1 第一節 研究背景與動機 1 第二節 研究目的 3 第二章 文獻探討 4 第一節 終止透析相關文獻探討 4 第二節 重症病患末期生命照護的相關議題 7 第三節 影響醫師提出終止治療的相關因子探討 9 第三章 研究方法 10 第一節 研究架構 10 第二節 研究流程 11 第三節 研究對象 12 第四節 研究設計 13 第五節 資料處理與分析方法 15 第四章 研究結果 16 第一節 描述性統計 16 第二節 卡方檢定 33 第三節 邏輯式迴歸分析 45 第五章 討論 51 第一節 研究結果討論 51 第二節 研究限制 59 第六章 結論與建議 60 第一節 結論 60 第二節 建議 61 參考文獻 62 附錄 70 表4-1. 各情境之代表意義 17 表4-2: 各構面問題及其代表意義 18 表4-3: 受訪者之基本資料 19 表4-4: 情境一描述性統計分析 21 表4-5: 情境二描述性統計分析 22 表4-6: 情境三描述性統計分析 23 表4-7: 情境四描述性統計分析 24 表4-8: 情境五描述性統計分析 25 表4-9: 基本資料變項與情境一同意退出透析與否相關性 35 表4-10: 基本資料變項與情境二同意退出透析與否相關性 37 表4-11: 基本資料變項與情境三同意退出透析與否相關性 39 表4-12: 基本資料變項與情境四同意退出透析與否相關性 41 表4-13: 基本資料變項與情境五同意退出透析與否相關性 43 表4-14: 多變項分析-情境一~五 47 表4-15: 多變項分析(控制基本變項)-情境一~五 49 圖一、研究架構 10 圖二、研究流程 11 圖4-1. 各情境之同意退出比例 26 圖4-2: 性別與各情境同意退出關係圖 27 圖4-3: 執業科別與各情境同意退出關係圖 28 圖4-4. 醫院所在地與各情境同意退出關係圖 29 圖4-5. 工作性質與各情境同意退出關係圖 30 圖4-6. 主要工作地點與各情境同意退出關係圖 31 圖4-7. 過去一年內是否主動提及退出透析建議與各情境同意退出關係圖 32 | |
| dc.language.iso | zh-TW | |
| dc.title | 醫師提出終止透析決策之影響因子分析 | zh_TW |
| dc.title | Factors Associated with Proposing Dialysis Withdrawal for Critically Ill ESRD Patients – Physicians’ Perspectives | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 98-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 江啟輝,黃燦龍 | |
| dc.subject.keyword | 終止透析,末期腎病,重症病患,決策,末期生命照護, | zh_TW |
| dc.subject.keyword | dialysis withdrawal,End-stage renal disease (ESRD),Critically-ill,decision-making,end-of-life care, | en |
| dc.relation.page | 77 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2010-08-15 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 醫療機構管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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