生死教育對經濟弱勢獨居老人死亡態度與預約善終之影響

Abstract

本研究目的在瞭解不同個人背景及環境經驗變項之經濟弱勢獨居老人，其死亡態度及預約善終意願的差異情形，以及瞭解生死教育課程介入對經濟弱勢獨居老人死亡態度及預約善終意願的影響。研究採「實驗組、控制組前、後測不等組」之準實驗設計，以臺北市某行政區經濟弱勢（低收或中低收入戶）、獨居且年滿65歲老人為研究對象，以結構式問卷進行資料蒐集，輔以課程單元評量表、課程總回饋表、課程紀錄作為參考資料，共收案實驗組老人33位，控制組老人30位。 研究工具包括研究對象之個人背景資料、環境經驗、死亡態度、對預立遺囑及預立醫療指示之意願等四部份的問卷，其中死亡態度採Wong、Reker和Gesser（1994）研發修訂之「死亡態度修訂量表」（DAP-R）之「死亡接受」三分量表，作為研究對象之死亡態度測量。資料蒐集後以SPSS 統計軟體進行問卷整理，再以次數分配、百分比、平均數、標準差等描述性統計，及卡方檢定、獨立t檢定、相依t檢定、單因子變異數分析、皮爾森積差相關、Cramer’V、階層迴歸等推論性統計進行資料分析。 在個人背景資料部份，實驗組及控制組老人的平均年齡分別為75.36歲及78.1歲，兩組老人的男性多於女性，學歷均以國小者最多，單身及獨居者最多，多有宗教信仰且虔誠度高，自覺身體及心理健康狀況好及很好者近五成或五成以上。環境經驗部份，兩組老人均以未得過嚴重疾病、有接觸死亡經驗者以及未曾與他人談論過死亡話題者為多。研究資料顯示兩組研究對象的個人背景資料及環境經驗並無顯著差異，表示實驗設計已控制這些可能造成影響的變項，使之不影響實驗效果。 兩組研究對象前測的死亡態度均以中性死亡接受的單一分量表得分最高，預約善終意願部份，實驗組及控制組的平均分數為47.45及45.43，未達顯著差異。顯示生死教育課程介入前，兩組老人的死亡態度及預約善終意願無顯著差異。 在生死教育課程介入後的後測資料顯示，實驗組老人的死亡態度及預約善終意願表現達顯著差異水準，表示生死教育課程可以有效影響經濟弱勢獨居老人的死亡及預約善終意願。 在個人背景資料與環境經驗對兩組老人死亡態度及預約善終意願的影響，研究資料顯示性別、有得過嚴重疾病會影響研究對象的死亡態度。而年齡、宗教信仰、身體健康狀況、有接觸死亡經驗及談論過死亡話題會影響研究對象的預約善終意願。 根據研究結果，分別對老人、老人生死教育、實務工作及未來研究方向提出建議，可作為未來發展老人生死教育者之參考，進而提升老人面對醫療決定及死亡課題的知識、態度與技巧，有效協助其面對善終。

This study intends to learn the difference of attitudes toward death and intention of making plan for a good death among the disadvantaged solitary elders of different personal backgrounds and environmental experiences, and to study the effect of involving death education program in the process. The study adopts the method of quasi-experimental design comprising pretest-posttest nonequivalent experimental group and control group. With the disadvantaged (low-income or middle-income) elders over the age of 65 who live alone in the administrative regions in Taipei as the subjects, the study collects data through structured questionnaires with the supplementary course unit assessment forms, overall course feedback forms and course records as references. The experimental group and the control group consist of 33 samples and 30 samples respectively. The research tools include questionnaire composed of four parts to investigate the study subjects’ personal background information, environmental experience, death attitude, and intention of making last will and making advance medical directives. As for the death attitude, it adopts the Three-Point Scale of Death Acceptance in Death Attitude Profile-Revised(DAP-R) developed and revised by Wong, Reker and Gesser(1994) to measure the death attitude of the study subjects. After collecting data, it sorts the questionnaires by SPSS statistical software, and then conducts data analysis by descriptive statistics such as frequency distribution, percentage, mean value and standard deviation and inferential statistics such as Chi-square test, independent t-test, dependent t-test, one-way ANOVA, Pearson product-moment correlation, Cramer’V and hierarchical regression. As for the part of personal background information, the average ages of the elders in the experimental group and control group are 75.36 and 78.1 respectively. In the two groups, the males are outnumbered by the females, and the education level of primary school takes up the largest proportion. Most of them are single or solitary with religious belief and strong piety. Nearly or over 50% believe they are in good or very good physical and mental health status. As for the environmental experience, most of the elders in these two groups haven’t suffered from serious disease, had a near death experience or talked about death with others. The data reveals the study subjects in these two groups don’t show significant difference in the personal background information and environmental experience, indicating the experimental design has controlled those variables which may possibly show influence and impact on the experimental effects. For the pretest death attitudes of the study subjects in the two groups, the subscale of neutral death acceptance gains the highest score. In the part of intention of making plan for a good death, the mean scores of the experimental group and control group are 47.45 and 45.43 respectively without significant difference. It means before involving the death education program, the elders of the two groups don’t show significant difference in their death attitudes and intention of making plan for a good death. The posttest data after involving death education program shows that the elders of the experimental group reaches significant difference in their death attitude and intention of making plan for a good death. It indicates the death education program could effectively influence the disadvantaged solitary elders in their death attitudes and intention of making plan for a good death. Regarding the influence of personal background information and environmental experience on the death attitude and intention of making plan for a good death of the elders in the two groups, the study data shows gender and serious disease experience will influence the death attitudes. Moreover, age, religious belief, physical health condition, experience of near death and death discussion will influence the intention of making plan for a good death. According to the study results, some suggestions are proposed for the elders, elders’ death education, practical work and future research direction, which can be taken as reference for those developing elders’ death education in the future, so as to improve the elders’ knowledge, attitudes and skills when facing medical decision and death topic, and effectively help them to face a good death.