癌症兒童生命末期照護型態相關因素之探討

Abstract

目的： 本研究欲瞭解台灣癌症兒童生命末期之照護型態，與照護積極性之程度。並以人口學特質、疾病特質與就醫場所特質等因素，探究其對生命末期照護及積極性程度之影響。 方法： 本研究係橫斷式之次級資料分析，使用國家衛生研究院1999年至2002年全民健康保險資料庫結合全國死亡檔，針對2000年至2002年間死亡之0-18歲癌症病童進行分析，研究對象共691位。 結果： 2000—2002年間，癌症兒童生命末期使用安寧緩和醫療之總比例為4.8％。安寧緩和醫療整合性照護試辦計畫於2000年7月實施後，隔年安寧緩和醫療使用比例自2.5%提昇為6.9%。主診斷為白血病、居住地點隸屬縣轄市，或就醫地點為中區分局者，使用安寧緩和醫療之比例較低。 無論是否使用安寧緩和醫療，3成以上癌症兒童於生命末期時仍使用住院或加護病房等高度醫療資源。年齡較小之病童，或就醫場所隸屬北區分局、中區分局、南區分局者，照護積極度較高。 結論： 台灣地區癌症兒童於生命末期時，（1）多半仍持續積極性照護；（2）使用居家安寧緩和醫療之比例低，且整體安寧緩和醫療使用情況呈現城鄉差距與地域差別；（3）推行「安寧療護整合性照護納入全民健康保險給付試辦計畫」有助於提昇安寧緩和醫療之使用。

Purpose： To explore the medical utilization patterns and aggressiveness of care for cancer children at the end of life, and its relationship to factors of demographics, disease and characteristics of medical institution. Method： The study was based on claim data from the Bureau of National Health Insurance (BNHI) from 1999 to 2002. There were 691 patients aged 18 and younger with a diagnosis of cancer between 2000 and 2002. Result： During the study period, average utilization rate of hospice services was 4.8 percent. After implementing the demonstration project by BNHI for comprehending the integrated care of hospices, study sample who received hospice care increased from 2.5 percent in year 2000 to 6.9 percent in year 2001. Patients with diagnosis of leukemia, living in county, or seeking medical services in areas covered by Central Branch of BNHI were related to fewer utilization rate of hospices. No matter using hospices or not, more than 30 percent children with cancer experienced admission to acute-care hospitals, intensive care unit, or had emergency department visit in the last month of life. Children who were younger or seeking medical services in areas covered by Northern Branch, Central Branch or Southern Branch, would have risk to experience higher aggressiveness of care compared with Eastern Branch of BNHI. Conclusion： In Taiwan, some children with cancer still received aggressive interventions at the end of life. The rate of receiving hospice homecare was low and the whole hospice services had disproportional distribution across the areas and the degree of urbanization. The demonstration project from BNHI for comprehending the integrated care of hospice services enhanced the use of hospice.