以利害關係人的觀點探討以病人為中心之照護-以社區安寧照護為例

Abstract

研究背景與目的 不論國內外均有學者在倡導「以病人為中心」照護的概念，美國醫學研究機構(IOM)也將以病人為中心納入21世紀健康照護目標當中。而在病人照護的過程中，末期照顧(end‐of‐life care)強調以病人為中心，追求合乎醫學倫理和醫療適切性的照顧。臺北市立聯合醫院自2015年1月起，各院區開始建立都會型社區安寧照護模式，組成跨專業之醫療照護團隊。醫療團隊成員親身經歷末期病人照護的歷程，並結合各種資源，將安寧療護的概念延伸至社區當中。過程中不僅得到來自病家純樸、溫暖的回響，也得到自我的成長與社區中病人家屬的肯定。本研究期望透過文獻資料蒐集與和社區安寧照護團隊成員進行訪談，藉以瞭解社區安寧照護團隊成員對於「以病人為中心」照護概念的經驗、態度以及落實的實際情形。 研究方法 本研究以質性訪談的方式，採用半結構式深度訪談法，編寫訪談大綱，對某區域醫院社區安寧照護團隊成員進行訪談，並針對相關文獻資料進行蒐集，來完成本研究的資料分析。 研究結果與結論 本研究之訪談收案時間自2015年6月16日至2015年7月16日截止，實際完成訪談的對象共計15名，醫師4名、護理人員7名以及社工師4名。結果發現要落實以病人為中心的概念，必須先瞭解病人本身真正的需求；利害關係人認為沒有辦法去落實以病人為中心的原因為受到醫院政策的限制。在社區安寧中沒有辦法達成以病人為中心理念的障礙是專業人員的不足，利害關係人認為可以透過來向民眾作教育及宣導(含死亡教育)，加強對於「以病人為中心」的概念。

Background and Purpose Whether domestically or internationally, scholars have advocated the concept of 'patient-centered care'. Institute of Medicine (IOM) also included patient-centered care in the 21st century health care goals. In the process of patient care, the end-of-life care emphasizes on a patient-centered care that aims to fulfill medical ethics and appropriateness. Since 2015, Taipei City hospital has provided hospice care in urban communities, where each branch began to develop a community-based palliative care model and forming a team of interdisciplinary health care professionals. Personal experiences on the care process of the terminally ill patients and a variety of other resources allows the medical team members to extend the concept of palliative care into the communities. Such process has not only received positive feedback from the patients' family, but it also gave medical team members an opportunity for self-growth and earning recognition from the patients' family. This study aimed to use data collection through literatures and interviews with community-based palliative care team members to understand their experience, attitude and implementation scenarios of the 'patient-centered care' concept. Study Methods In this study, qualitative interviews were conducted using semi-structured in-depth interviews to construct an interview outline, which was used to interview members of an unnamed area hospital's community-based palliative care team. Relevant literature reviews and documents were collected to complete the data analysis in this study.

Results and Conclusions This study began from June 16, 2015 to July 16, 2015, where a total of fifteen participants had completed the full interview. These participants included four doctors, seven nurses and four social workers. The result showed that to implement the concept of patient-centered care, understanding the real needs of the patients themselves was crucial; Stakeholders thought that difficulties in the implementation of patient-centered care concept was due to the restrictions from hospital's policy. The lack of professionals was the barrier that made stakeholders unable to achieve patient-centered care in community-based palliative care. Stakeholders also believed that the concept of patient-centered care could be strengthened by education and advocacy (including death education) to the public.