臺灣博碩士論文加值系統

鑑於無效醫療的研究多著重在醫療人員或倫理法律學家的見解，缺少民眾立場的觀點，本質性研究旨在探討居住於社區，75歲以上，且患有慢性病老人對無效醫療之看法。研究者以立意取樣收案，個別訪談9位居住於台南地區老人，將半結構式訪談過程，全程錄音，並轉錄為逐字稿。訪談資料以內容分析法進行分析，最後歸納五個主要主題與十三個次主題所構成。主題與次主題分別為：（1）感受無效處置存在－寄望醫療科技、依賴健保之福利、延長生命的痛苦、討論死亡議題；（2）重度慢性病造成家庭負荷－久病拖累家庭成員、加重經濟負擔、影響自身與家人情緒；（3）聽從醫師建議－尊重專業；（4）與慢性病共存－學習與疾病共處、重視銀髮健康、找尋社會支持；（5）醫療指示需及時－接受安寧意願高、對預立醫療指示存有不確定感。本研究結果可促使醫療相關單位及政府重視民眾對無效醫療的看法，進而帶動社區高齡長者對安寧療護和病人自主權利相關知識之提升。

Most studies of futile care focus on the perspective of ethicists, lawyers, and health care providers. This qualitative study explores perceptions of medical futility in community-dwelling older adults 75 years or older with chronic illnesses. Nine older adults were recruited through purposive sampling to participate in individual face-to-face interviews. These semi-structured interviews were audio-taped, transcribed verbatim and analyzed by content analysis. Five themes and thirteen sub-themes emerged from the data: (1) Sense of medical futility: expectations of medical technology, dependence on the National Health Service, prolonging the agony of life, discussion of death-related issues; (2) Severe chronic disease as a caregiver’s burden: encumbering family members, financial burden, physical and psychological burden; (3) Compliance with the physician's advice: respect toward professionals; (4) Living with chronic disease: learning to live with the disease, watching for health problems, looking for social support; and (5) Documenting advance directives in a timely manner: favoring palliative care, uncertainty regarding advance directives. Study findings may help health-related institutions understand medical futility from the perspective of health care consumers, which will allow them to better inform community-dwelling old adults about palliative care and the Patient Autonomy Bill.

指導教授推薦書……………………………………………………………………………………………………………………………………………………………………………
口試委員會審定……………………………………………………………………………………………………………………………………………………………………………
授權書………………………………………………………………………………………………………………………………………………………………………………………………
致謝………………………………………………………………………………………………………………………………………………………………………………………………I
中文摘要…………………………………………………………………………………………………………………………………………………………………………………III
英文摘要……………………………………………………………………………………………………………………………………………………………………………… IV
目錄………………………………………………………………………………………………………………………………………………………………………………………………V
表目錄……………………………………………………………………………………………………………………………………………………………………………………VIII
第一章 緒論…………………………………………………………………………………………………………………………………………………………………………1
第一節 研究背景、動機及重要性…………………………………………………………………………………………………………………………………1
第二節 研究問題…………………………………………………………………………………………………………………………………………………………………7
第三節 名詞解釋…………………………………………………………………………………………………………………………………………………………………7
第二章 文獻查證…………………………………………………………………………………………………………………………………………………………………8
第一節 慢性病與高齡化老人……………………………………………………………………………………………………………………………………………8
第二節 無效醫療之概念與相關研究……………………………………………………………………………………………………………………………10
第三節 無效醫療之倫理觀……………………………………………………………………………………………………………………………………………15
第四節 無效醫療與安寧緩和醫療之相關性………………………………………………………………………………………………………………18
第三章 研究方法………………………………………………………………………………………………………………………………………………………………21
第一節 研究設計………………………………………………………………………………………………………………………………………………………………21
第二節 研究對象與樣本數及研究場所………………………………………………………………………………………………………………………22
第三節 研究工具………………………………………………………………………………………………………………………………………………………………23
第四節 收集資料的方法…………………………………………………………………………………………………………………………………………………26
第五節 資料處理的方法…………………………………………………………………………………………………………………………………………………28
第六節 研究嚴謹度…………………………………………………………………………………………………………………………………………………………32
第七節 研究倫理………………………………………………………………………………………………………………………………………………………………35
第四章 研究結果與討論…………………………………………………………………………………………………………………………………………………37
第一節 基本資料分析………………………………………………………………………………………………………………………………………………………37
第二節 主題分析與討論…………………………………………………………………………………………………………………………………………………39
第五章 研究結論與建議…………………………………………………………………………………………………………………………………………………77
第一節 研究發現………………………………………………………………………………………………………………………………………………………………77
第二節 綜合討論………………………………………………………………………………………………………………………………………………………………80
第三節 建議………………………………………………………………………………………………………………………………………………………………………85
第四節 限制………………………………………………………………………………………………………………………………………………………………………87
參考文獻
中文文獻……………………………………………………………………………………………………………………………………………………………………………………88
英文文獻……………………………………………………………………………………………………………………………………………………………………………………99
附錄一 研究參與者訪談說明書及同意書…………………………………………………………………………………………………………………103
附錄二 受訪者基本資料…………………………………………………………………………………………………………………………………………………106
附錄三 訪談日誌………………………………………………………………………………………………………………………………………………………………107
附錄四 人類行為科學研究倫理審查委員會審查通過證明函………………………………………………………………………………………

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