社群傳播之介入影響民眾對病人自主權利法認知與態度之探討

Abstract

研究背景：西元2019年1月6日《病人自主權利法》施行，對保障病人醫療自主權利、病人拒絕醫療與善終的權利，帶來重大觀念上的改變，顛覆了過去國人不顧一切搶救到底的刻版印象。這亞洲第一部保障病人自主權利的專法-《病人自主權利法》在台灣正式施行後，臺灣民眾對此的認知與態度為何，以及媒體傳播扮演的效果如何，值得進行探究。 研究目的：本研究擬藉由社群平台傳播發送問卷，了解民眾對政府推動《病人自主權利法》的認知與態度，以及透過媒體傳播後是否有所改變。 研究方法：透過網路發送匿名問卷，讓身分證尾數為偶數民眾觀看《病人自主權利法》專題影片於觀看前、後調查其認知與態度情形，並讓身分證尾數為奇數民眾觀看《安寧療護》專題影片前、後進行調查其認知與態度情形作為對照組。實驗組和對照組各收集至少500名。本研究利用 SAS 統計軟體進行分析。針對個人基本資料如性別、年齡、婚姻狀態、宗教信仰、教育程度、居住地區、薪資收入、健康狀況，進行描述性統計分析包括人數與百分比，接著再進行雙變項分析，包括卡方檢定(X2)，最後再利用複羅吉斯迴歸分析及差異中的差異來比較實驗組與對照組在認知與態度上的差異，調整的干擾因子包括性別、年齡、婚姻狀態、宗教信仰、教育程度、居住地區、薪資收入及健康狀況。 研究結果：本研究共收集1,276筆（對照組610位、實驗組666位），對照組與實驗組的人口學比例，在性別上男性分別佔了43.61%與43.84%；在觀看新聞專題影片前，有關認知的題目：您知道簽署預立醫療決定書前，需要諮商及收取2,000~3,500元不等的費用嗎？對此訊息表達非常清楚與清楚的認知的機率，實驗組是對照組的1.507倍（95% 信賴區間為1.090-2.084)。當各個題目在觀看新聞專題影片後，利用複羅吉斯迴歸分析認知與態度在實驗組與對照組別上的差異，9題中有3題達到統計顯著差異。您知道《病人自主權利法》(簡稱病主法)於西元2019年1月6日，正式施行嗎？對於此題表示非常清楚與清楚的機率，實驗組是對照組的2.646倍 (95%信賴區間2.004-3.494)；您對《病人自主權利法》的內容了解嗎？對於此題表示非常了解與了解的機率，實驗組是對照組的2.264倍 (95%信賴區間1.712-2.994)；您知道簽署預立醫療決定書前，需要諮商及收取2,000~3,500元不等的費用嗎？對此訊息表示非常清楚與清楚的機率，實驗組是對照組的4.281倍（95%信賴區間為3.291-5.569)。 結論:在觀看新聞專題影片後，知道《病人自主權利法》(簡稱病主法)於西元2019年1月6日，正式施行嗎？對《病人自主權利法》的內容了解嗎？您知道簽署預立醫療決定書前，需要諮商及收取2,000~3,500元不等的費用嗎？三個題目都能有效達到媒體宣傳效果，民眾在觀看影片前後的認知和態度都有顯著的差異。

Background: The “Patient Right to Autonomy Act “of the Republic of China came into effect on January 6, 2019. Implementation of this act has brought about a major change in the concept of protecting patients' medical autonomy, patients' rights to refuse medical treatment. It undermined stereotyping and impression formation of a target population in the past. After the official implementation of the “Patient Right to Autonomy Act ', the first Asian law to protect patients' autonomy rights, what are the knowledge and attitudes of the Taiwanese people about this, and how effective is media communication? Purpose: This objective of this study was to distribute questionnaires through social networks to understand the public's knowledge and attitudes towards the government's promotion of the 'Patient Right to Autonomy Act' and whether there has been any change after dissemination through the media. Methods: Anonymous questionnaires were distributed via the Internet to allow people with an even-numbered mandatory ID card to assess patients’ knowledge and attitude before and after watching a special film on the Patient Right to Autonomy Act. Those with odd-numbered ID cards (that is, the control group) were then allowed to watch the 'Hospice Care' film before and after assessments of their knowledge and attitudes. The experimental and control group each recruited at least 500 people. The statistical analysis system (SAS) software (version 9.4) was used for analysis. Basic characteristics included gender, age, marital status, religious beliefs, educational history, living area, salary income, health status, and others. Descriptive statistical analysis was presented as number and percentages. This was followed by bivariate analyses, such as Chi-square test (X2). Finally, multiple logistic regression analysis with difference-in-difference (DID) was used to compare differences in knowledge and attitude between the experimental and control group. Adjusted variables included gender, age, marital status, religious beliefs, educational level, living area, salary income, and health status. Results: A total of 1,276 individuals were recruited in this study (i.e., n = 610 for the control group and n = 666 for the experimental group). The proportion of men in the control and experimental group was 43.61% and 43.84%, respectively. Before watching the films, differences in knowledge and attitudes between experimental and control groups were assessed using multiple logistic regression analysis while adjusting confounding factors. Only the fourth question reached statistical significance. That is, “Do you know that before signing the pre-medical decision, you need to consult and be charged a fee ranging from 2,000 to 3,500 NT dollars?” To clearly assess this question, the experimental group was 1.507 times more likely to know the regulation than the control group (95% confidence interval, 1.090-2.084). After watching the film, multiple logistic regression analysis was used to assess differences in perceptions and attitudes between the experimental and the control group. Three of the 9 questions on perceptions and attitudes were statistically different. They were: “Did you know that the Patient Right to Autonomy Act was be officially implemented on January 6, 2019?” Regarding the likelihood of knowing the date, the OR was 2.646 (95%CI: 2.004-3.494). That is, the experimant group was 2.646 times more likely to know the date than the control group. “Did you know the content of the patient autonomy law?” For the level of knowledge of this question (i.e., very well understood), the OR was 2.264 (95%CI: 1.712-2.994). “Did you know you would need to consult and be charged a fee ranging from 2,000 to 3,500 NT dollars before the medical decision?” The experimental group was 4.281 times more likely to be very clear about the regulation than the control group (95%CI: 3.291-5.569). Reaching a statistical significance indicates that the experimental group had a higher degree of cognition than the control group. Conclusions: After watching the film,”Did you know that the Patient Right to Autonomy Act was officially implemented on January 6, 2019?”;”Did you understand the content of the Patient Right to Autonomy Act?”; and “Did you know that before signing the medical decision, you would need to consult and be charged a fee ranging from 2,000 to 3,500 NT dollars?” The three questions can effectively address the effect of media propaganda, and there are significant differences in respondents' knowledge and attitudes before and after watching the film.