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研究生:廖芳陞
研究生(外文):Liao, Fang-Sheng
論文名稱:德爾菲法(Delphi method)應用於台灣醫療委任代理人(health care agent)角色功能及任務內涵分析
論文名稱(外文):An analysis on the eligibility factor and the task content of health care agents in Taiwan-applying Delphi method
指導教授:吳俊德吳俊德引用關係張永富張永富引用關係
指導教授(外文):Wu, Chun-TeChang, Yong-Fu
口試委員:蘇子炘陳柏翰
口試委員(外文):Su, Tzu-HsinChen, Po-Han
口試日期:2015-07-22
學位類別:碩士
校院名稱:遠東科技大學
系所名稱:創新設計與創業管理研究所
學門:商業及管理學門
學類:其他商業及管理學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:中文
論文頁數:108
中文關鍵詞:醫療委任代理人德爾菲法(Delphi method)資格要素任務內涵
外文關鍵詞:Health Care AgentDelphi methodeligibility ElementMission Element
相關次數:
  • 被引用被引用:7
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台灣已經步入高齡化社會的階段,再加上少子化現象的衝擊,這對於未來醫療照護系統與醫病關係的發展勢必進入另一種緊張的關係,老齡化所形成的就醫需求,少子化所衍生的家庭成員就醫、照護的問題,讓醫療委任代理人制度設計逐漸引起各界的重視。
本研究中將分別探討國外先進國家在醫療委任代理人的發展歷程、趨勢與現況。並且初步探討在台灣現行的健保制度與社會環境的條件下醫療委任代理人所需的資格要素及其任務內涵,以為往後我國發展醫療委任代理人的基礎。本研究運用德爾菲法(Delphi method),通過不同類群專家意見的表達、對話、匯整的過程,尋求對於醫療委任代理人的資格要素及任務內涵共識。每一個人的生命都是有限的,本研究的目的在讓每一個人步入生命的終點時,都有權利為自己做一個最好的安排,透過醫療委任代理人制度以成就善生、善活與善終的生命歷程,改變現有醫療體系為求自保而過度進行處置的現況,尋求完善的生命體驗。 本論文採用德爾菲法(Delphi method)觀點來分析醫療委任代理人制度的設計,從資格要素及任務內涵分析進行現況的分析與討論。
本研究受訪對象包括醫藥、長照、法律、健保署等相關從業人員共26人,經由前測、前導測試與三回合德爾菲法分析,研究結果產生(1)在台灣的醫療現況,大多數領域專家同意設立「醫療委任代理人」之制度;(2)各界領域專家同意:不可以忽略病人先前所預立的醫療計畫;(3)各界領域專家同意「醫療委任代理人」制度可能有效減少無效醫療或徒勞醫療(futile medical care)的問題;(4)各界領域專家同意善終的可能要件為「尊重病人自主決定 」,同意「醫療委任代理人」可能最主要的任務是幫助病人善終……………等九項結論,供後續研究之參考。

關鍵字:醫療委任代理人、德爾菲法(Delphi method)、資格要素、任務內涵

Resulting from the aging of population and the low rate of birth, the doctor-patient relationship in Taiwan health care system would be bound into another tense relationship in the future. The aging of population would get rise to the medical needs and the problem of medical treatment and health care would be derived from the low birth rate. Therefore, the institution of health care agent has been brought to public attention in Taiwan.
First of all, in this investigation, the histories and prevalence of health care agent institutions in different developed countries were investigated. Next, considering Taiwan health care system and society environment, the elements of health care agent task connotation and eligibility were explored in order to further develop Taiwan health care agent institutions. In this study, Delphi method was applied to converge the viewpoints of different experts about the elements of health care agent task connotation and eligibility. Everyone’s life time is limited. The purpose of the study is that everyone who faces the end of life has the right to make their best arrangement thought the institution of health care agent. To change the overtreatment in healthcare and the culture of self-protection, the institution of the health care agent should be applied so as to seek for a human good life experience.
The respondents of this study consisted of 26 specialists from the medical institutes, long-term health care houses, law firms and Ministry of Insurance and Welfare. After the pre-test, pilot study and three round Delphi tests, the results of this study reached a consensus on nine major issues, including: 1) under the current circumstance of Taiwan’s medical care conditions, most specialists agree with the inauguration of a health care agent system; 2) most specialists agree that a patient’s advanced medical plan should not be neglected; 3) a health care agent system can reduce the futile medical care problem; 4) a human good life experience results from the necessity of valuing a patient’s independent decision.
Key words: Health Care Agent, Delphi method, eligibility Element, Mission Element

目  錄
誌 謝 I
摘 要 II
ABSTRACT III
目 錄 IV
表目錄 VI
圖目錄 VII
第壹章 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 研究流程 2
第貳章 文獻回顧 3
第一節 各國醫療委任代理人(health care agent)制度的發展現況 3
一、美國 3
二、德國 4
三、法國 5
四、台灣的現況 6
第二節 資格要素 9
第三節 任務內涵 9
第四節 德爾菲法(Delphi method) 10
一、德爾菲法的簡介 10
二、德爾菲法之構成要素 11
三、德爾菲法(Delphi Technique)的優缺點 13
第叁章 研究方法設計與步驟 14
第一節 問卷設計流程 14
第二節 實施步驟 15
第三節 問卷設計內容 15
第四節 研究對象之選擇 16
第五節 問卷調查執行情況 18
一、一回合前測與一回合前導測試及德爾菲法三個回合問卷執行過程 18
第六節 本章小結 20
第肆章 資料結果分析 21
第一節 德爾菲法專家意見收斂 21
第二節 德爾菲法三回合問卷調查結果資格要素分析 22
第三節 德爾菲法三回合問卷調查結果任務內涵分析 35
第伍章 結論與建議 46
第一節 結 論 46
第二節 研究貢獻與實務意涵 46
第三節 未來研究方向 47
第陸章 參考文獻 48
一、中文參考文獻 48
二、英文參考文獻 49
附錄一 52
附錄二 59
附錄三 66
附錄四 76
附錄五 86
作者簡歷 108

一、中文參考文獻
1.王英偉(2013)。預立醫療自主計畫 Retrieved from http://www.hospice.org.tw/2009/ chinese/book/F14.pdf。
2.內政部外籍配偶照顧輔導基金補助研究報告─外籍配偶照顧輔導基金績效指標建構之研究,頁34-53。
3.方慧芬、張慧玉、林佳靜(2009)。末期病人面臨預立醫囑、生前預囑之現況及與生命自決之倫理議題。護理雜誌,56(1), 17-22。
4.江弘基 & 李蘭(2003)。管理式醫療照護下的醫病信任議題。
5.宋文娟,2001〈一種質量並重的研究方法:德菲法在醫務管理學研究領域之應用〉,《醫務管理期刊》,2(2): 11-20。
6.吳建昌。預立醫療指示之倫理問題。Retrieved from: www.tsim.org.tw/article/A96/ B6-04.pdf。
7.林美蓮。生死抉擇─談末期病人自主權 Retrieved from: http://site.jah.org.tw/jah_rm/ pdf/7_edu/ 1_subject/2005/2005-21.pdf。
8.邱泰源(2007)。末期醫療照護之常見倫理困境與決策。澄清醫護管理雜誌,3(3), 4-9。
9.邱淑芬 & 蔡欣玲(1996)。德菲法預測術─種專家預測的護理研究方法。護理研究,4(1), 92-98。
10.柯群(1982)。德爾菲法。科学管理研究,(5), 11-11。
11.胡文郁、楊嘉玲(2009)。生命末期之病情告知與預立照護計畫。護理雜誌,56(1), 23-28。
12.孫效智(2012)。安寧緩和醫療條例中的末期病患與病人自主權。政治與社會哲學評論(41),45-91。
13.張嘉芳(2009)。思考、行動、溝通─為什麼要推動「預立醫療自主計劃」。Retrieved 4/23, 2015, from http://www.hospice.org.tw/2009/chinese/share_view.php?cate=1&info =57。
14.程雅慧(2012)。新安寧運動─預立醫療自主計劃(Advance Care Planning)。高雄醫師會誌,20(1),15-18。Retrieved from 高雄市醫師公會 website: http://www.doctor. org.tw/file/74-3-3.pdf。
15.筱菁(2006)。老人安養護,長期照護機構社會工作者工作困擾影響因素之探討。慈濟大學社會工作研究所學位論文,1-143。
16.蔡甫昌、方震中、陳麗光 & 王榮德(2012)。長期呼吸器依賴病患撤除維生治療之倫理法律議題。台灣醫學,16(2),156-173。
17.蔡甫昌、潘恆嘉、吳澤玫、邱泰源、黃天祥(2006)。預立醫療計畫之倫理與法律議題。臺灣醫學,10(4),517-536。
18.趙可式(2009)。台灣安寧療護的發展與前瞻。護理雜誌,56(1),5-10。
19.衛生福利部(2013)。安寧緩和醫療條例。Retrieved 4/23, 2015, from http://www.tho.org. tw/xms/toc/list.php?courseID=14。
20.顏啟華。機構式照護的醫學倫理觀。台灣老年學暨老年醫學會會訊,(52)。Retrieved from 台灣老年學暨老年醫學 website: http://www.tagg.org.tw/DOWN/%E6%9C %83%E8%A8%8A/52%E6%9C%9F/%E6%A9%9F%E6%A7%8B%E5%BC%8F%E7%85%A7%E8%AD%B7%E7%9A%84%E9%86%AB%E5%AD%B8%E5%80%AB%E7%90%86%E8%A7%80%28%E9%A1%8F%E5%95%9F%E8%8F%AF%29.pdf。
21.臺灣醫界,Vol.58 No.2, Feb 2015,頁43-47。

二、英文參考文獻
1.Aging with Dignity (2010). Five-wishes. 2010年12月12日取自 http://www. agingwithdignity.org/five-wishes.php.
2.Amella, E. J. (2003). Geriatrics and palliative Care. Journal of Hospice & Palliative Nursing, 5, 40-48.
3.Biola, H., Sloane, P. D., Williams, C. S., Daaleman, T. P., Williams, S. W., & Zimmerman, S.(2007). Physician communication with family caregivers of long-term care residents at the end of life. Journal of the American Geriatrics Society, 55(6), 846-856.
4.Black, K. & Fauske, J. (2008). “Measuring case managers' advance care planning practice: Translating focus group findings to survey development.” Care Management Journals, 9(4): 166-176.
5.Blackford, J., E. Strickland, et al. (2007). “Advance care planning in residential aged care facilities.” Contemporary Nurse: A Journal for the Australian Nursing Profession, 27(1), 141-151.
6.Coventry, P. A., Grande, G. E., Richards, D. A., & Todd, C. J. (2005). Prediction of appropriate timing of palliative care for older adults with non-malignant life-threatening disease: A systematic review. Age and Ageing, 34(3), 218-227.
7.Davies, E., & Higginson, I. J. (Eds.). (2004). Better palliative care for older people.Copenhagen: WHO Regional Office for Europe.
8.Fernandes, G. (2008). Implementation of best practice in advance care planning in an 'ageing in place' aged care facility. International Journal of Evidence-Based Healthcare, 6(2), 270-276.
9.Holman, D., & Hockley, J. (2010). Advance care planning -- The 'What', the 'Why', the 'How and when' -- A UK perspective. Singapore Nursing Journal, 37(4), 10-16.
10.Houttekier, D., Cohen, J., Bilsen, J., Addington-Hall, J., Onwuteaka-Philipsen, B. D., & Deliens, L. (2010). Place of death of older persons with dementia. A study in five European countries. Journal of the American Geriatrics Society, 58(4), 751-756.
11.Jeong, S. Y., Higgins, I., & McMillan, M. (2007). “Advance care planning (ACP): The nurse as 'broker' in residential aged care facilities.” Contemporary Nurse: A Journal for the Australian Nursing Profession, 26(2), 184-195.
12.Liao, S., & Ackermann, R. J. (2008). Interdisciplinary end-of-life care in nursing homes. Clinical Gerontologist, 31(4), 83-96.
13.Linstone,H.A.and M.Turoff,1975 “Introduction to The Delphi Method: Techniques and Applications,” in H.A.Linstone and M.Turoff(eds), The Delphi Method : Techniques and pplications, Reading, MA, pp.3-12. Addision-Wesley Publishing Company.
14.Lusk, C. (2007). The need for palliative/end-of-life care programs in LTC. Canadian Nursing Home, 18(4), 9-15.
15.Lyon, C. (2007). Advance care planning for residents in aged care facilities: What is best practice and how can evidence-based guidelines be implemented? International Journal of Evidence-Based Healthcare, 5(4), 450-457.
16.Malcomson, H., & Bisbee, S. (2009). Perspectives of healthy elders on advance care planning. Journal of the American Academy of Nurse Practitioners, 21(1), 18-23.
17.Menec, V. H., Nowicki, S., Blandford, A., & Veselyuk, D. (2009). Hospitalizations at the end of life among long-term care residents. The Gournals of Gerontology. Series A, Biological sciences and medical sciences, 64(3), 395-402.
18.Mullen,P.M.,2003 “Delphi: Myths and Reality: ” Journal of Health Organization and Management, 17(1): 37-52.
19.Murrary, T.J., L.L.Pipino, and J.P. van Gigch, 1985 “A Pilot Study of Fuzzy Set Modification of Delphi” Human Systems Management, 5: 76-80.
20.Palangkaraya, A., & Yong, J. (2009). Population ageing and its implications on aggregate health care demand: empirical evidence from 22 OECD countries. International Journal of Health Care Finance and Economics, March 20.
21.Shanley, C., Whitmore, E., Khoo, A., Cartwright, C., Walker, A., & Cumming, R. G. (2009). Understanding how advance care planning is approached in the residential aged care setting: A continuum model of practice as an explanatory device. Australasian Journal on Ageing, 28(4), 211-215.
22.Sudore, R. L., Schickedanz, A. D., Landefeld, C. S., Williams, B. A., Lindquist, K., Pantilat,S. Z., et al. (2008). Engagement in multiple steps of the advance care planning process: A descriptive study of diverse older adults. Journal of the American Geriatrics Society, 56(6), 1006-1013.
23.Truog, R. (2008). End-of-life decision-making in the United States. European Journal of Anaesthesiology, 25(S42), 43-50.
24.Wiesing, U., Jox, R., Hessler, H., & Borasio, G. (2010). A new law on advance directives in Germany. Journal of medical ethics, 36(12), 779-783.
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