探討加護病房家屬對疾病末期病人醫療決策行為意向及其影響因素

Abstract

本研究旨在探討加護病房家屬對疾病末期病人醫療決策行為意向及其影響因素，採立意取樣，使用結構式問卷。訪談60位北部某醫學中心內外科加護病房之疾病末期病患家屬。將所收集之資料，以SPSS11.0版進行統計分析。重要結果為：（1）85％家屬同意讓疾病末期病人在加護病房內接受緩和性治療。（2）僅25％家屬聽過安寧緩和醫療條例。（3）91.7％家屬認為醫師第一個應告知家屬疾病末期病人之病情。（4）加護病房家屬對疾病末期病人之「真相告知態度」、「末期醫療處置態度」及「末期醫療決策行為意向」均較正向。（5）加護病房家屬認為病人之生活品質為4.58分，且五成認為病人未達善終。（6）「家屬對病人生活品質看法」之重要預測因子為「簽署DNR同意書」及「有看過他人CPR且有被影響」。（7）「末期醫療決策行為意向」之重要預測因子為「真相告知態度」及「末期醫療處置態度」。（8）「家屬對適切性醫療滿意度」之重要預測因子為「病人住ICU起始日至家屬受訪日」及「病人存活時間」。（9）「病人善終與否」之重要預測因子為「家屬對適切性醫療滿意度」及「病人存活時間」。（10）「有無簽屬DNR同意書」之重要預測因子為「家屬與病人關係」及「醫療決策行為意向」。研究結果讓醫護人員瞭解加護病房家屬，在做末期醫療決策行為時之重要預測因子。以利提供適當之護理措施、減少醫療資源之浪費，並藉著病情真相告知，間接促進病人善終之達成。

The aim of this study was to investigate the factors influenced the behavior intention of medical decision and targeting on the families with terminal patients at intensive care units(ICU).A purposive sampling method was used in.60 families.This data was analyzed by the software of SPSS11.0 version. The important findings are: (1) When the patients are at the terminal stage of their diseases, 85% of their families are willing to have hospice care at ICU. (2) The Regulations of Hospice Care are known by only 25% of the families. (3) When the patients are at the terminal stage of their diseases,91.7% of their families consider themselves as the first ones to be informed by the doctors. (4) The family of the patients at ICU have a positive attitude toward “truth telling”, “the treatment for terminal stage”, and “terminal medical decision making”. (5) The family of the patients at ICU think the patients’ life quality score was 4.58 in average, and half of them feel that the patients do not have good dying. (6) “DNR agreement” and “having seen CPR to others and having been influenced” are significant predictors to “how the patients’ family think about patients’ life quality”. (7) Regarding to the attitudes of patients’ families, “attitudes toward truth telling” and “the treatment for terminal stage” are significant predictors to “attitudes towards terminal decision making”. (8) “The time interval from the first day of ICU admission to the day of interview” and “patients’ survival time” are significant predictors to “the family’s satisfaction of appropriate medical care”. (9) “The family’s satisfaction of appropriate medical care” and “patients’ survival time” are significant predictors to “ the familiy’s opinion of the patient’s good dying”. (10) “The family - patient relationship” and “attitudes toward terminal decision making” are significant predictors to “DNR agreement”.The results of this study can help medical professionals understand the factors and significant predictors of the terminal decision making by the family of the patients at ICU. It may facilitate us to implement appropriate nursing strategies for terminal patients at ICU and to reduce the medical cost. “Truth telling” is helpful for patients’ good dying.