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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 董鈺琪(Yu-Chi Tung) | |
| dc.contributor.author | Wei-Min Chu | en |
| dc.contributor.author | 朱為民 | zh_TW |
| dc.date.accessioned | 2023-03-19T22:42:48Z | - |
| dc.date.copyright | 2022-10-03 | |
| dc.date.issued | 2022 | |
| dc.date.submitted | 2022-08-12 | |
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/85087 | - |
| dc.description.abstract | 研究背景與目的： 末期透析病人是近年來接受安寧緩和醫療的末期非癌症病患中，數量成長最快速的。當生命走到近終點時，是否要持續維持生命治療—如血液透析—，或是面對未來可能須接受更侵入性維持生命治療—如插管、呼吸器等—之抉擇，常常是病人和家屬難以抉擇的問題，除了病人和家屬的壓力之外，也造成了照顧和社會成本的增加。本研究主要的目的是探討末期透析病人是否有接受安寧緩和醫療與生命末期照護品質的相關性，期待透過全國性的回溯性資料分析，釐清安寧緩和醫療對於末期透析病人的效益，包含生命末期積極照護利用與醫療費用，並進一步分析何種安寧緩和醫療模式對於末期透析病人的效益較高。 研究方法： 本研究以回溯性世代研究分析，運用台灣健保資料庫中2017年全國的末期透析病人，了解死亡前一年的安寧照護利用率、安寧照護針對透析病人生命末期照護品質的效益、以及不同安寧照護模式帶來的影響，同時分析影響末期透析病人生命末期照護品質的決定因子。 研究結果： 共有10,083位末期透析病人被納入研究中，其中有1,786位病人(17.7%)在死亡前一年有接受安寧緩和療護，而8,297位病人(82.3%)死亡前沒有接受安寧緩和療護。所有病人的平均死亡年齡為73.6歲。末期透析病人在死亡前接受安寧照護可顯著降低死前30天超過一次急診(勝算比0.68)、死前30天超過一次住院(勝算比0.62)、死前30天使用急性加護病房(勝算比0.70)、在醫院死亡(勝算比0.93)、死前30天使用插管(勝算比0.38)、死前30天使用呼吸器(勝算比0.83)、死前30天使用心肺復甦術(勝算比0.23)、死前30天使用鼻胃管、胃造口或全靜脈營養(勝算比0.91)以及二項積極照護分數比率。而在生命末期醫療費用方面，是否有接受安寧緩和照護並不會顯著降低死亡前30天醫療費用。 結論： 這個全國性的觀察性研究分析了超過一萬名末期透析死亡病人的生命末期照護品質，結果顯示安寧緩和醫療，特別是混和安寧緩和醫療模式、安寧住院照護與安寧居家照護，都可以顯著降低病人死亡前的積極治療措施。而安寧共同照護相對來說對於降低積極性治療的效果較差。衛生主管機關與政策制定者應該設法將安寧緩和醫療融入末期透析病人的臨床照護模式當中，並且試圖促進腎臟照護團隊與安寧照護團隊的對話、溝通和合作，以提升末期腎病病人與家屬的生活品質。 | zh_TW |
| dc.description.abstract | Background: Patients with end-stage renal disease (ESRD) under regular dialysis are a particularly important population with a heavy disease burden. However, evidence related to palliative care for patients with ESRD under regular dialysis remains scarce, especially for palliative care consultation services and palliative home care. This population-based observational study aimed to evaluate the effects of different palliative care models on aggressive treatment and medical costs during the end of life (EOL) among ESRD patients under regular dialysis. Methods: This population-based study used a population database maintained by Taiwan’s Ministry of Health and Welfare in combination with Taiwan’s National Health Research Insurance Database. We enrolled all decedents who were ESRD patients under regular dialysis from Jan 01, 2017 to Dec 31, 2017 in Taiwan. Hospice care during the one year before death was documented, and we analyzed the relationship between different palliative care models and treatment aggressiveness during EOL by multivariate logistic regression. Also, we examined the relationship between different palliative care models and medical costs within 30 days before death. Results: A total of 10,083 patients were enrolled, and 1,786 (17.7%) ESRD patients received palliative care within one year before death. Compared with patients with no palliative care, patients with palliative care during the EOL had significantly less aggressive treatment during the EOL (Estimates: -0.09, Confidence interval: -0.10- -0.08). Patients with inpatient palliative care, palliative home care, and mixed model had significantly lower treatment aggressiveness during the EOL. Whether to receive palliative care or not before death did not significantly decrease medical costs within 30 days before death. Conclusions: Palliative care, especially the mixed care model, inpatient palliative care, and palliative home care in ESRD patients under dialysis during the EOL, could significantly reduce the aggressiveness of treatment during the EOL. | en |
| dc.description.provenance | Made available in DSpace on 2023-03-19T22:42:48Z (GMT). No. of bitstreams: 1 U0001-0908202216234600.pdf: 990118 bytes, checksum: 10b749a8a45c45ccb6c7ce9c52c66f8f (MD5) Previous issue date: 2022 | en |
| dc.description.tableofcontents | 致謝 i 中英文摘要 iii 目錄 vii 表目錄 ix 圖目錄 x 第一章 緒論 1 第一節 研究背景與動機 1 第二節 研究目的 2 第三節 研究重要性 3 第二章 文獻探討 4 第一節 透析病人之全球盛行率與台灣現況 4 第二節 安寧緩和醫療對於末期病人的好處 7 第三節 生命末期照護品質之測量與安寧緩和醫療 10 第四節 末期病人生命末期照護品質之實證研究 12 第五節 綜合評論 15 第三章 研究方法 16 第一節 研究設計與架構 16 第二節 研究假說 18 第三節 研究對象 19 第四節 資料來源與資料處理流程 20 第五節 研究變項操作型定義 21 第六節 統計分析方法 24 第四章 研究結果 25 第一節 描述性統計 25 第二節 不同安寧照護模式的差異分析 29 第三節 多變項分析 34 第五章 討論 39 第一節 研究結果簡述 39 第二節 研究結果與其他相關研究之異同 40 第三節 研究優點與限制 44 第六章 結論與建議 45 第一節 結論 45 第二節 建議 46 參考文獻 48 | |
| dc.language.iso | zh-TW | |
| dc.title | 末期透析病人死亡前使用安寧緩和醫療與否之生命末期照護品質與照護費用影響 | zh_TW |
| dc.title | Impact of quality of care and costs of care among terminal patients with maintenance dialysis receiving hospice-palliative care before death | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 110-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 楊銘欽(Ming-Chin Yang),傅彬貴(Pin-Kuei Fu) | |
| dc.subject.keyword | 安寧緩和醫療,末期腎臟病,透析治療,生命末期照護品質, | zh_TW |
| dc.subject.keyword | Hospice-palliative care,End stage renal disease,Dialysis,Quality of life,End-of-life, | en |
| dc.relation.page | 54 | |
| dc.identifier.doi | 10.6342/NTU202202211 | |
| dc.rights.note | 同意授權(限校園內公開) | |
| dc.date.accepted | 2022-08-15 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
| dc.date.embargo-lift | 2022-10-03 | - |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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