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研究生:呂郁芳
研究生(外文):Yu-Fang Lu
論文名稱:失智者及其家屬預立醫療決定之影響因素與困難及需求協助之探討
論文名稱(外文):Advance directives and its influencing factors,difficulties and assistant needs among patients with dementia and their families
指導教授:葉錦雪葉錦雪引用關係
指導教授(外文):Ching-Hsueh Yeh
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:護理學系碩士班
學門:醫藥衛生學門
學類:護理學類
論文出版年:2020
畢業學年度:108
語文別:中文
論文頁數:125
中文關鍵詞:失智症生命末期預立醫療決定倫理議題
外文關鍵詞:Dementiaend of lifeadvance directiveethic issue
相關次數:
  • 被引用被引用:0
  • 點閱點閱:71
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  • 下載下載:6
  • 收藏至我的研究室書目清單書目收藏:1
研究背景:失智者照護上有許多倫理議題,然而,不同於其他末期
疾病,隨著失智症疾病發展,決策能力受影響,無法明確表達自身
醫療偏好,疾病末期的預立醫療決定為迫切且重要的照顧倫理議
題。
研究目的:探討失智者及其家屬預立醫療決定之影響因素與困難及
需求協助。
研究方法:本研究為質量型混合式研究設計,採立意及滾雪球取樣
方式,以半結構式問卷訪談收集資料,失智者及其家屬的基本資料
採描述性統計分析,開放式問題以內容分析法,將失智者及家屬在
預立醫療決定的原因、困難、所需的協助的相關資料進行分類與歸
納。
研究結果:八成以上的失智者未簽屬預立醫療決定相關文件,在預立
醫療決定相關經驗及需求上,七成五以上的失智者未跟家屬討論過生
命末期預立醫療決定的相關議題;失智者家屬在簽屬預立醫療決定方
面:有八至九成的人不曾替失智者簽署預立醫療決定相關的同意書。
在預立醫療決定相關經驗及需求上,分別有六成至九成的人不曾和失
智者討論過生命末期預立醫療決定的相關意願,在跟誰討論過失智者
生命末期預立醫療決定的相關話題中: 曾和家人討論者為
6.25~34.37%、曾和醫護人員討論者低於1 成。開放式問題中,失智
者簽立預立醫療決定的原因及困難歸納之主題為失智者本身對此項
議題不了解;其所需的協助歸納之主題為家屬及醫護團隊協助。影響
失智者家屬簽立預立醫療決定的原因及困難歸納之主題為病情嚴重
度、談論死亡的禁忌、傳統孝道觀念、家人意見、主要決策者、資訊
不足、醫護支持;其簽立預立醫療決定所需的協助歸納之主題為增加
資訊的普及度,例如政府主動的訊息提供與醫護主動提供醫療端的協
助。
結論:本研究結果反映了失智者對於預立醫療決定的相關議題不熟悉,
可以透過相關協助,如發放衛教單張、辦理相關講座、大眾媒體的傳
播,以及醫護人員能夠提供相關的衛教及解說,以促進失智者及其家
屬進一步思考生命末期自身的醫療偏好;此份調查將有助於醫護團隊
更了解失智者或失智者家屬的難處,未來期能製作失智者及家屬擬定
預立醫療決定照護計畫時所需的衛教手冊、影片與照護指引。
Background:Many ethical issues exist in dementia care, however,
unlike the other disease progression, the cognitive function of dementia
declines obviously before its end stage. As the disease deteriorates from
moderate to severe stage, the medical decision-making is difficult to be
expressed to represent these patients’ own medical autonomy. The
advanced directives (AD) for medical decision before the end stage of the
disease is an urgent and important ethical issue.
Research objectives:The research purpose is to investigate AD and
its influencing factors, difficulties, and assistant needs among patients with
dementia and their families.
Research method:A mixed methods research design with purposive
and snowball sampling method was used. The semi-structured
questionnaire interview was used to collect data. The descriptive statistical
analysis was used to analyze demographic characteristics of demented
persons and their families. Content analysis was used to induct and classify
the opening questions.
Result:More than 80% of the demented persons did not sign the
relevant documents of the advance directives. More than 75% of the
demented persons did not discuss the AD at the end of life with their
families. 80% ~ 90% families of demented persons did not sign the relevant
documents of the advance directives. 60% ~ 90% have not discussed the
willingness of medical decisions for end of life with demented persons. In
regard to the discussion of AD, 6.25-34.37% demented persons had
discussed with family members, and less than 10% with healthy providers.
According to the interview for opening questions, the themes of
influencing factors and difficulties showed the dementia patients
misunderstood the issue of AD. The theme of assistant needs for this was
the assistance from family members and the health provider. The theme of
influencing factors and difficulties showed the families of dementia
patients were the severity of the illness, the taboo about death, traditional
filial piety, family opinions, main decision makers, insufficient information,
and medical support. The theme of assistant needs for this was to increase
the penetration of related information, such as the initiative of the
government and medical assistance from health providers.
Conclusion:The results of this study showed dementia patients and
their family are unfamiliar with the related issues of AD. With providing
further assistance, such as health education leaflets, lectures, and media
dissemination, health education and explanation from the health providers,
it could enhance their further consideration about the medical preferences
at the end of life. This investigation could help the health providers to
understand the difficulties of demented persons or their families in
advanced care planning (ACP). Future research is to make the health
education materials, videos, and care guidelines of ACP for them.
目錄
第一章 緒論 ......................................... 1
第一節 問題背景及重要性 .............................. 1
第二節 研究目的 ..................................... 5
第二章 文獻查證與概念架構............................. 6
第一節 文獻查證...................................... 6
第二節 研究架構 ..................................... 17
第四節 名詞解釋 ..................................... 18
第三章 研究方法 ..................................... 20
第一節 研究設計 ..................................... 20
第二節 研究情境/場所 ................................ 20
第三節 研究樣本及取樣樣本特性與樣本數抽樣方法 .......... 20
第四節 資料收集 ..................................... 22
第五節 資料分析 ..................................... 23
第六節 倫理考量 ..................................... 25
第四章 研究結果 ..................................... 26
第一節 研究對象之人口學屬性 .......................... 26
第二節 開放式問題 ................................... 35
第五章 討論 ......................................... 48
第一節 研究結果與研究目的的關聯性 ..................... 48
第二節 研究限制 ..................................... 73
第六章 結論與建議 ................................... 75
參考文獻
.................................................... 79
附錄 ............................................... 91
文本萃取範例 ........................................ 91
人體試驗同意書、半結構問卷 ........................... 96
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