臺灣博碩士論文加值系統

平均餘命的延長及死亡率的下降，使得經歷死亡的機會減少，而於生命盡頭要使用維生治療延長生命或預立DNR維持生命末期生活的品質，是醫療人員與病患的兩難，因此本研究的目的是探討老年人對於DNR的認識，以及他們對於不同的身體狀態使用維生治療的態度，並能分析出影響老年人對於維生治療使用的相關因素。
以中部某榮民之家住民為例，共收集131份問卷，年齡介於68-98歲，藉由實際的照片說明三種LST：心肺復甦術、鼻胃管、氣管內管，以5種不同身體狀態下對於3種維生治療的態度，並探討人口學的特性、健康狀況、社會支持、活的意願、懼怕臨終及死亡、臨終的醫療決定等，對於維生治療態度的相關性及影響。
研究中結果顯示，由於樣本的平均年齡近82歲及生活背景的特殊性，因此人口學的變項對於維生治療的態度並沒有影響，大部分的老年人不願意使用LST維持生命，自評身體情況愈差、日常活動功能依賴者，愈不願意使用維生治療，活的意願愈強愈要使用維生治療，老年人想要討論關於臨終的醫療決定，但他們希望醫師能主動與病患討論維生治療。
建議加強一般社區居民及機構內的老人，甚至醫療人員關於DNR觀念的宣導，機構照顧必須學習瞭解老年人的生活經驗及方式，提供適當的關懷與協助，協助獲得更好的生活適應，並找到生命的意義與價值，安然面對人生的終點。
關鍵字：維生治療、不施行心肺復甦術意願書、心肺復甦術、活的意願、懼怕臨終及死亡

One of the dilemmas concerning end of life care is that expensive medical treatments are delivered to prolong lives without significant improvement in quality of life. The purpose of this study is to explore factors that may be associated with the wishes for life-sustaining treatments (LST) among a group of residents lived in a veteran’s home in central Taiwan.
A total of 131 relative healthy elders, age ranged from 68 to 98, were interviewed by a trained nurse practitioner. The respondents were presented pictures and a detailed descriptions of three types of LST, cardiopulmonary resuscitation (CPR), breathing machines, and tube feeding, before soliciting their opinions regarding the use of LST under five different scenarios. The respondents’ wish for LST was correlated with their demographic characteristics, health status measures, Will to live, Fear of death, social support, and influences from past experiences.
Results indicate that, for this old sample of elders (nearly 82 years old in average), less medical intervention of any kind is the norm. For the “diagnosed of cancer with a good chance of recovery” scenario, 69.5% of the respondents would decline tube feeding if they were unable to swallow. Percentages for declining breathing machine and CPR were 76.3% and 76.4%, respectively. Plus, those who perceived their health improved (compared to a year ago) and those who rated their health better than that of their peers were more likely to wish for LST.
Key word: life sustaining treatments, Do-Not-Resuscitate, cardiopulmonary resuscitation, will to live, fear of dying and death

目錄
第一章 緒論
第一節 研究動機與背景 1
第二節 研究目的 5
第三節 名詞解釋 6
第二章 文獻探討
第一節 臨終照護的相關問題 8
第二節 預立醫囑的相關問題 13
第三節 影響維生治療的相關因素討論 17
第三章 研究方法
第一節 研究對象及範圍 22
第二節 研究架構及問卷設計 25
第三節 研究變項的操作型定義及測量 26
第四節 資料統計與分析 34
第五節 研究倫理 35
第四章 研究結果
第一節 信度分析 36
第二節 描述性統計 38
第三節 統計分析結果 52
第五章 討論
第一節 基本人口學特徵及維生治療的相關 67
第二節 健康情形與維生治療的相關性 70
第三節 臨終醫療決定等及維生治療的態度及相關性探討 72
第六章 結論與建議
第一節 結論 75
第二節 建議 77
第三節 研究限制及未來研究方向 79
文獻參考
中文文獻 80
英文文獻 82
附錄一 問卷內容 87
附錄二 預立醫囑 95
附錄三 維生治療圖例 97
附錄四 MMSE量表 99
附錄五 機構同意執行問卷公文 100
表目錄
表4-1-1 信度分析之調查量表 36
表4-1-2 信度分析 38
表4-2-1 樣本人口特質次數分配與百分比 41
表4-2-2 樣本疾病類別次數分配與百分比 42
表4-2-3 疾病經驗及社會支持次數分配與百分比 43
表4-2-4 五種身體狀況對LST的意願次數分配與百分比 47
表4-2-5 臨終醫療決定次數分配與百分比 50
表4-3-1 LST的單因子變異數分析、次數及百分比 58
表4-3-2 LST的相關檢定 61
表4-3-3 維生治療的線性迴歸分析 66

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