臺灣博碩士論文加值系統

當疾病已無法治癒而醫療卻面臨極限時，死亡乃為不可避免之事；在臨床上有限的環境與人力條件下，使生命末期病人有機會接受安寧共同照護與安寧居家照護服務。安寧照護團隊藉由提供善終準備服務，來協助這些病人達身體、心理、社會與靈性的平安，希望在不同照護模式中，即使照護地點的不同，病人的善終準備程度能達到一定的善終品質。本研究旨在，探討接受不同安寧照護模式的病人其善終準備程度與善終品質之關係，進一步了解在接受不同安寧緩和照護模式病人之善終準備執行程度、善終品質，以及在接受不同安寧緩和照護模式下之善終準備程度與善終品質。
本研究採用病歷回溯之研究設計，收集中部某一區域教學醫院，接受安寧共同照護服務或接受安寧居家照護服務之病人為對象，收集其病歷中具善終準備與善終品質資料、且死亡地點為醫院或在宅死亡之個案。共收案197名，其中接受安寧共同照護者為129名、接受安寧居家照護為68名，男女各佔一半，多數為癌症病人，接受安寧照護總天數平均為28天，平均年齡74.35歲，38.6%的病人希望接受善終地點為自己的家。
研究結果發現：接受不同安寧緩和照護模式個案，其善終準備執行程度上於統計上有顯著差異(t = -7.29，p < 0.001)，而接受安寧居家照護模式個案較接受安寧共同照護個案，獲得更完整的善終準備服務，當善終準備完成度越高，病人之善終品質越好。在善終品質方面，接受安寧居家個案之分數亦高於安寧共同照護之個案，統計上具有顯著差異(t = -11.012，p < 0.05)。另外，接受安寧共同照護及安寧居家照護個案之善終準備程度與結案時善終品質指標間呈現中度正相關(r = 0.637，p = < 0.001 vs. r = 0.428，p = <0.001)，表示接受安寧照護個案之善終準備程度越高其善終品質越好。本研究建議在安寧臨床照護中，專業人員應增強對於善終準備的認知及認同感，使生命末期之病人無論在任何專業領域照顧下，都有機會接受到適當的臨終照護服務，達到處處有安寧的目標，進而提升生命末期個案獲得良好的善終品質照護。

When the disease is incurable and medical is facing the limitation, death becomes an inevitable event. With limited clinical environment and manpower condition, terminal patients could possibly receive hospice shared care and hospice home care. With service for preparation of good death, the hospice care group assists these patients to achieve physical, mental, social and spiritual calmness. Even if the care locations are varied, we hope the preparation of good death could reach a certain quality of good death under different hospice mode. Therefore, the main purpose of this study is to investigate the relationship between quality of good death and preparation of good death under different hospice care modes, and further understand the preparation and quality of good death under different hospice and palliative care modes.
A retrospectively observational study was conducted at one regional hospital in central Taiwan. The subjects were patients who received hospice shared care or hospice home care and died at the hospital or at home. The material for preparation and quality of good death from medical records were collected. The number of subjects was 197, 129 of them received hospice shared care, 68 of them received hospice home care. Male and female are both 50 percent, and most of them were cancer patients. The average of hospice care days was 28, and the average age was 74.35, 38.6 percent hoped the location of a good death was their own house.
The results revealed, there was obvious significance (t = -7.29, p < 0.001) on statistics between different hospice and palliative care modes. Cases who received hospice home care obtained better preparation of good death than those who received hospice shared care. The quality of a good death was better when the preparation work was better completed. On the quality of good death, there was obvious significance (t = -11.012, p < 0.05) on statistics. The scores of cases who received hospice home care were also higher than those who received hospice shared care. Besides, the preparation of good death and the quality of good death index showed moderate relevance (r = 0.637, p < 0.001 vs. r = 0.428, p < 0.001). It represented the quality of a good death was better when the preparation work was better completed. The suggestion of this study is that professionals should improve the acknowledgement and identity for the preparation of good death. Making terminal patients received appropriate hospice and palliative care wherever they are. To achieve the target of hospice care service everywhere, and hence enhance the quality of good death for every terminal patient.

致謝..................................................................i
摘要..................................................................ii
第一章　緒論...........................................................1
第一節　前言...........................................................1
第二節　研究背景.......................................................2
第三節　研究動機與重要性................................................4
第四節　研究目的.......................................................7
第五節　研究問題.......................................................7
第六節　研究理論與研究架構..............................................7
第七節 名詞界定........................................................11
第二章　文獻查證.......................................................13
第一節　安寧療護發展與現況..............................................13
第二節　善終...........................................................24
第三章　研究方法.......................................................33
第一節　研究設計.......................................................33
第二節　收案場所與收案對象..............................................33
第三節　研究工具.......................................................35
第四節　資料蒐集過程...................................................37
第五節　資料整理分析...................................................38
第六節　研究倫理考量...................................................39
第四章　研究結果.......................................................40
第一節　接受不同安寧照護模式個案基本屬性分析..............................40
第二節　接受不同安寧緩和照護模式個案其善終準備執行狀況.....................44
第三節　接受不同安寧緩和照護模式個案與善終品質指標差異.....................45
第四節　不同照護模式個案其善終準備與善終品質之相關性.......................46
第五章 討論............................................................48
第一節　接受不同安寧緩和照護模式研究對象之基本屬性.........................48
第二節　不同安寧緩和照護模式個案其善終準備執行程度差異.....................50
第三節　接受不同安寧緩和照護模式個案與善終品質指標差異.....................51
第四節　接受不同安寧照護模式其善終準備與善終品質之相關.....................51
第六章 結論與建議.......................................................53
第一節　結論............................................................53
第二節　研究限制........................................................54
第三節　建議............................................................55
參考文獻................................................................59
附件一..................................................................68
附件二..................................................................72

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