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研究生:謝淑娟
研究生(外文):HSIEH SHU-CHUAN
論文名稱:預測安寧居家病人如願在家死亡之因素
論文名稱(外文):Predictors of death at home in Patients under hospice home care
指導教授:許雅娟許雅娟引用關係
指導教授(外文):Hsu, Ya-Chuan
口試委員:陳清惠
口試委員(外文):CHEN, CHING-HUEY
口試日期:2022-07-22
學位類別:碩士
校院名稱:長榮大學
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
論文種類:學術論文
論文出版年:2022
畢業學年度:110
語文別:中文
論文頁數:67
中文關鍵詞:在家死亡安寧居家療護
外文關鍵詞:dying at homehome care hospice
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「在家死亡」是多數病人期待的死亡地點,但最終是否能夠如期所願善終於熟悉的地方,仍受一些人口及疾病特性因素所影響,過去國內外對癌症病人在家死亡相關因素的研究指出年齡、性別、不同的婚姻狀況與在家死亡的相關性有不一致的定論。當病人與主要照顧者選擇在家死亡具有一致性想法,能增加病人在家死亡的機會,而主要照顧者與病人的關係是否會影響病人如願在家死亡值得進一步研究。國外已有不少針對癌症及非癌症病人在家死亡的相關性研究,當國內把安寧居家照護對象擴及非癌症病人時,需要更多研究來瞭解其影響病人在家善終的因素。因此本研究目的旨在探討接受安寧居家照護病人如願在家死亡之預測因素。
本研究為病歷回溯相關性研究設計(retrospective correlational study),以安寧居家電子病歷數據資料。南部某醫學中心安寧居家病人為方便樣本。收案條件包括:需符合安寧居家收案條件且有確實接受安寧居家照護並已死亡者、從收案到死亡均在家中接受照顧或死亡前有住院者、病歷有明確記載死亡地點、病歷有明確記載病人及家屬皆有表達期望臨終地點。收案人數共373位。資料使用SPSS22版電腦軟體分析,以卡方檢定及邏輯式回歸推論性統計進行資料分析。
結果發現安寧居家病人實際在家死亡有152人(佔40.8%),非在家死亡有221人(佔59.2%)。基本屬性對安寧居家病人選擇在家死亡的因素,年齡及性別無顯著影響(X2=0.43, p=0.513;X2=0.22, p=0.637)。婚姻狀況、癌症/非癌症、死亡前14天有無入院史及與主要照顧者關係則有顯著影響(X2=4.14, p=0.042;X2=4.93, p=0.026、X2=80.80, p=<.001、X2=6.69, p=0.010)。在邏輯式迴歸分析婚姻狀況、癌症/非癌症、死亡前14天有無入院史、與主要照顧者關係是影響安寧居家照護病人在家及非在家死亡重要預測因素。已婚病人在家死亡的倍率是未婚病人的1.54倍(95%CI=1.01-2.33,p=0.042);癌症病人在家死亡的倍率是非癌症病人的1.62倍(95%CI=1.05-2.49,p=0.027);死亡前14天無入院史病人在家死亡的倍率是死亡前14天有入院史病人的13.91倍(95%CI=7.13-27.12,p=<.001);與主要照顧者是親屬關係的病人在家死亡的倍率是非親屬關係的1.89倍(95%CI=1.162-3.062, p=0.010)。
此研究結果檢視病人能如願在家死亡的預測因素包括婚姻狀況、癌症疾病、死亡前14天有住院史、親屬關係的主要照顧者,有助於提供安寧居家醫療團隊在面對病人臨終照顧的衛教指導及溝通之參考。
關鍵字:在家死亡、安寧居家療護
Predictors of death at home in Patients under hospice home care
Abstract
Dying at home is desired by most patients. However, whether patients can depart their life at a place they are familiar with is affected by various demographic and disease characteristic factors. Previous studies in Taiwan regarding factors related to dying at home among patients with cancer have not reached a consistent conclusion on the correlation between dying at home and patient age, sex, and marital status. When patients and their primary caregivers agree on dying at home, the likelihood of this occurrence may increase. Whether the relationship between patients and their primary caregivers affects the patients’ desire to death at home merits further exploration. Multiple international studies have explored the correlation of the desire to death at home among patients with and without cancer. To incorporate patients without cancer as targets of home care hospice in Taiwan, further research should be conducted to understand the factors affecting peaceful dying at home. The objective of this study is to explore the predictors of dying at home desired by patients receiving home care hospice.
The convenient sample of this retrospective correlational study consisted of electronic medical record data of patients receiving home care hospice in a medical center in southern Taiwan. The inclusion criteria were deceased patients who were eligible for home care hospice and received such care before death; patients who received home care from the moment of being included in this study to the time of death or who was hospitalized but returned home before death; patients whose medical record clearly specifies the location of death; and patients whose medical record notes the desired location of death specified by the patient and family member(s). A total of 373 patients were included. The collected data were analyzed using SPSS version 22 through inferential statistics, namely the chi-squared test and logistic regression.
The results revealed that 152 of the patients death at home (40.8%), and 221 did not (59.2%). Of the demographic variables, age and sex nonsignificantly affected patients’ choice to die at home (X2 = 0.43, p = 0.513; X2 = 0.22, p = 0.637), whereas their marital status, development of cancer, record of hospitalization 14 days prior to death, and relationship with the primary caregiver exerted a significant effect (X2 = 4.14, p = 0.042; X2 = 4.93, p = 0.026; X2 = 80.80, p = <0.001; X2 = 6.69, p = 0.010). The logistic regression revealed that marital status, development of cancer, record of hospitalization 14 days prior to death, and relationship with the primary caregiver were significant predictors of dying at home. The likelihood of married patients death at home was 1.54 times that of single patients (95% CI = 1.01–2.33, p = 0.042). The likelihood of patients with cancer dying at home was 1.62 times that of patients without cancer (95% CI = 1.05–2.49, p = 0.027). The likelihood of dying at home for patients who were not hospitalized 14 days prior to death was 13.91 times that of patients who were hospitalized (95% CI = 7.13–27.12, p = 0.001). The likelihood of dying at home for patients who were primarily cared by kinship caregivers was 1.89 times that of patients without such caregivers (95% CI = 1.162–3.062, p = 0.010).
This study examined the predictors of dying at home desired by the patients and identified the main factors as patients’ marital status, development of cancer, record of hospitalization 14 days prior to death, as well as whether patients were primarily cared by kinship caregivers. The study results could serve as a reference for medical teams of home care hospice to provide health education and communicate with patients.

Keywords: dying at home, home care hospice
目錄
第一章 緒論....................................... 1
第一節重要性及動機...................... 1
第二節研究目的.......................... 5
第三節研究問題......................... . 5
第四節名詞界定........................... 6
第二章文獻探討................................. ...8
第一節台灣安寧居家療護的現況..............8
第二節安寧居家服務與死亡地點的相關研究……10
第三節影響選擇在家死亡的相關因素..........13
第三章研究方法................................ ....21
第一節 研究架構......................... .21
第二節 研究設計...........................22
第三節 研究對象......................... .23
第四節 資料收集過程.......................24
第五節 研究工具......................... .25
第六節 資料擷取及步驟................... .26
第七節 資料處理及分析.................... 29
第八節 研究倫理考量...................... 32
第四章 結果........................................33
第一節安寧居家病人基本屬性...............33
第二節安寧居家病人實際死亡地點分布.......35
第三節基本屬性與在家死亡與否相關性.......36
第四節基本屬性與病人和主要照顧者是否一致期
待在家死亡相關性...................38
第五節基本屬性對是否在家死亡之影響.......40
第五章 討論.........................................42
第一節 安寧居家病人實際死亡地點分布.......42
第二節 基本屬性與在家死亡相關性...........46
第三節 基本屬性與病人和主要照顧者是否一致期
待在家死亡相關性...................49
第四節 安寧居家病人在家死亡與否預測因素....50
第六章 限制.........................................52
第七章 建議.........................................53
第八章 結論.........................................55





內政部戶政司(2021).15縣市死亡人口死亡地點。https://www.ris.gov.tw/app/portal/346
內政部統計處(2022).內政統計查詢網。
https://statis.moi.gov.tw/micst/stmain.jsp?sys=220&ym=11006&ymt=11106&kind=21&type=1&funid=c0110201&cycle=41&outmode=0&compmode=0&outkind=1&fldlst=1001&cod00=1&rdm=3q5rIqla
內政部統計處(2022).內政部租屋人口。
https://www.google.com/search?rlz=1C1CAFC_enTW945TW945&q=%E5%85%A7%E6%94%BF%E9%83%A8%E7%A7%9F%E5%B1%8B%E4%BA%BA%E5%8F%A3&sa=X&ved=2ahUKEwizi73oo_D4AhUCVt4KHZ4UAv4Q1QJ6BAgoEAE&biw=1920&bih=969
呂宜峰、林宛玲、楊啟正、楊君宜、許家禎(2021).執行預立醫療決定時照護地點與死亡地點之初探.安寧療護雜誌,25(3),223-238。
全國法規資料庫(2022,1月13日) .老人福利機構設立標準。 https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=d0050039
李隆軍、胡中傑、黃曉峰、林鉅勝、張瑛瑛(2011).癌症末期病人安寧居家的主要照顧議題分析.安寧療護雜誌,16(2),151-167。
施采樺、黃采薇(2021).從國內居家整合照顧計畫探討安寧緩和整合照護模式新契機.腫瘤護理雜誌,21(1),5-17。
邱智鈴、陳巧怡、張凱玲(2019).末期病人在宅善終挑戰.腫瘤護理雜誌,17,51-54。
林家穗、王枝燦、賴維淑(2020).華人傳統文化對國人善終選擇之影響.安寧療護雜誌,24(1),1-16。
高以信、賴育民、江瑞坤、陳世琦(2011).安寧病房老年癌末病人14日內存活期之預測-依據病人的臨床特徵及實驗室檢查.台灣家醫誌,21(1),15-26。
高以信、劉耀庭、柯美伶、蘇盈惠、魏美琴、江瑞坤(2016).探討癌末病人接受居家安寧療護後在宅善終的相關因子.安寧療護雜誌,21(2),141-153。
陳儀倩、黃智玉、林碧莉(2020) .影響安寧居家護理病人在宅往生之因素.安寧療護雜誌,24(3),209-224。
陳榮基(2015).我國安寧緩和照護之相關政策的過去發展與未來展望.護理雜誌,62(2),13-17。
張慧美、林清壽(2021).影響中高齡者簽署預立醫療決定書之相關因素研究.福祉科技與服務管理學刊,9(2),123-139。
張麗蓉、陳雅智、謝宗成、黃彥晴(2014).肺癌新診斷病人非計畫性入院及預測相關因素之探討.志為護理,13(5),76-87。
黃銘源、林承霈(2019).臨終之處與其影響因素之探討.安寧療護雜誌,23(3),254-266。
黃裕雯(2012) .安寧居家療護.於許禮安總校閱,安寧緩和療護(一版,166-182) .華杏。
傅秀英、李佳琳、黃慈心、謝素英、王宏銘(2014).桃園某地區醫院安寧病房住院病人的服務分析.長庚護理,25(4),375-388。
衛生福利部中央健保署(2021).108年死因結果統計分析。https://dep.mohw.gov.tw/DOS/cp-4927-54466-113.html
衛生福利部中央健保署(2011年4月1日) .全民健康保險安寧共同照護試辦方案。https://www.nhi.gov.tw/Resource/webdata/27915_2_1040801%20%E5%AE%89%E5%AF%A7%E5%85%B1%E7%85%A7%E8%A9%A6%E8%BE%A6%E6%96%B9%E6%A1%88.pdf
衛生福利部(2022,5月9日) .高齡及長期照顧統計專區。https://dep.mohw.gov.tw/dos/cp-5223-62358-113.html#_4.%E9%95%B7%E6%9C%9F%E7%85%A7%E9%A1%A7
Alonso-Babarro, A., Bruera, E., Varela-Cerdeira, M., Boya-Cristia, M. J., Madero, R., Torres-Vigil, I., De, C. J., & González-Barón, M. (2011). Can this patient be discharged home? Factors associated with at-home death among patients with cancer. Journal of Clinical Oncology, 29 (9), 1159-1167. https://doi.org/10.1200/JCO.2010.31.6752
Beng, A. K., Fong, C. W., Shum, E., Goh, C. R., Goh, K. T., & Chew, S. K. (2009). Where the elderly die: the influence of socio-demographic factors and cause of death on people dying at home. Annals Academy of Medicine Singapore, 38(8), 676-683
Cohen, J., Houttekier, D., Onwuteaka-Philipsen, B., Miccinesi, G., Addington-Hall, J., Kaasa, S., Bilsen, J., & Deliens, L. (2010). Which patients with cancer die at home? A study of six European countries using death certificate data. Journal of Clinical Oncology, 28 (13), 2267-2273. https://doi.org/10.1200/JCO.2009.23.2850
Choi, J. E., Miyashita, M., Hirai, K., Sato, K., Morita, T., Tsuneto, S., & Shima, Y. (2010). Preference of place for end-of-life cancer care and death among bereavedJapanese families who experienced home hospice care and death of a loved one. Supportive Care in Caner, 18, 1445-1453. https://doi.org/10.1007/s00520-009-0767-3
Dixon, J., King, D., & Knapp, M. (2019). Advance care planning in England: Is there an association with place of death? Secondary analysis of data from the National Survey of Bereaved People. BMJ Supportive and Palliative Care, 9(3), 316-325. https://doi.org/10.1136/bmjspcare-2015-000971
Escobar, P. L. C., Weber, M., Claus, M., Fischbeck, S., Unrath, M., Martini, T., & Münster, E. (2011). Factors influencing place of death in Germany. Journal of Pain and Symptom Management, 41(5), 893-903. https://doi.org/10.1016/j.jpainsymman.2010.07.016
Ernecoff, N. C., Wessell, K. L., Hanson, L. C., Dusetzina, S. B., Shea, C. M., Weinberger, M., & Bennett, A. V. (2020). Elements of Palliative Care in the Last 6 Months of Life: Frequency, Predictors, and Timing. Journal of General Internal Medicine, 35(3), 753-761. https://doi.org/10.1007/s11606-019-05349-0
Fukui, S., Yoshiuchi, K., Fujita, J., Sawai, M., & Watanabe, M. (2011). Japanese people’s preference for place of end-of-life care and death: A population-based nationwide survey. Journal of Pain and Symptom Management, 42(6), 882-892. https://doi.org/ 10.1016/j.jpainsymman.2011.02.024
Gomes, B., Higginson, I. J., & McCrone P. P. (2016). Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Sao Paulo Medical Journal, 134(1), 93-94. https://doi.org/10.1590/1516-3180.20161341T2
Ho, B. J., Akhileswaran, R., Pang, G. S. Y., & Koh, G. C. H. (2017). An 11-year study of home hospice service trends in Singapore from 2000 to 2010. Journal of Palliative Medicine, 20(5), 461-472. https://doi.org/ 10.1089/jpm.2016.0268
Hsieh, M. C., Huang, M. C., Lai, Y. L., & Lin, C. C. (2007). Grief reactions in family caregivers of advanced cancer patients in Taiwan: Relationship to place of death. Cancer Nursing, 30(4), 278-284. https://doi.org/10.1097/01.NCC.0000281728.72243.c4
Jeurkar, N., Farrington, S., Craig, T. R., Slattery, J., Harrold, J. K., Oldanie, B., & Casarett, D. J. (2012). Which hospice patients with cancer are able to die in the setting of their choice? Results of a retrospective cohort study. Journal of Clinical Oncology, 30(22), 2783-2787. https://doi.org/10.1200/JCO.2011.41.5711
Lee, L. C., Hu, C. C., Loh E. W., & Hwang, S. F. (2014). Factors affecting the place of death among hospice home care cancer patients in Taiwan. American Journal Hospice and Palliative Care, 31(3), 300-306. https://doi.org/10.1177/1049909113487427
Lovell, N., Jones, C., Baynes, D., Dinning, S., Vinen, K., & Murtagh, F. E. (2017). Understanding patterns and factors associated with place of death in patients with end-stage kidney disease: A retrospective cohort study. Palliative Medicine, 31(3), 283-288. https://doi.org/10.1177/0269216316655747
Nakamura, S., Kuzuya, M., Funaki, Y., Matsui, W., & Ishiguro, N. (2010). Factors influencing death at home in terminally ill cancer patients. Geriatrics and Gerontology International, 10(2), 154-160. https://doi.org/10.1111/j.1447-0594.2009.00570.x
Natsume, M., Watanabe, K., Matsumoto, S., Naruge, D., Hayashi, K., Furuse, J., Kawamura, M., Jinno, H., Sano, K., Fukushima, R., Osawa, G., Aruga, E., Hashiguchi, Y., Tanaka, A., Takikawa, H., & Seki, N. (2018). Factors influencing cancer patients' choice of end-of-life care place. Journal of Palliative Medicine, 21(6), 751-765. https://doi.org/ 10.1089/jpm.2017.0481
Riolfi, M., Buja, A., Zanardo, C., Marangon, F., Manno, P., & Baldo, V. (2014). Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: A retrospective cohort study. Palliative Medicine, 28(5), 403-411. https://doi.org/10.1177/0269216313517283
Skorstengaard, M. H., Neergaard, M. A., Andreassen, P., Brogaard, T., Bendstrup, E., Løkke, A., Aagaard, S., Wiggers, H., Bech, P., & Jensen, A. B. (2017). Preferred place of care and death in terminally ill patients with lung and heart disease compared to cancer patients. Journal of Palliative Medicine, 20(11), 1217-1224. https://doi.org/ 10.1089/jpm.2017.0082
Shih, C. Y., Hu, W. Y., Cheng, S. Y., Yao, C. A., Chen, C. Y., Lin, Y. C., & Chiu, T. Y. (2015). Patient preferences versus family physicians' perceptions regarding the place of end-of-life care and death: A nationwide study in Taiwan. Journal of Palliative Medicine, 18(7), 625-630. https://doi.org/10.1089/jpm.2014.0386
Tang, S. T., Chen, C. C., Tang, W. R., & Liu, T. W. (2010). Determinants of patient-family caregivr congruence on preferred place of death in Taiwan. Journal of Pain and Symptom Management, 40 (2), 235-245. https://doi.org/10.1016/j.jpainsymman.2009.12.018
Yeung, N. Y. (2020). Expectation of the place of care and place of death of terminal cancer patients in Hong Kong: a hospital based cross-sectional questionnaire survey. Annals of Palliative Medicine, 9(6), 4534-4548. https://doi.org/10.21037/apm.2019.09.17
Zhuang, Q. Lau, Z. Y., Ong, W. S., Yang, G. M., Tan, K. B., Ong, M. E. H., & Wong, T. H. (2020). Sociodemographic and clinical factors for non-hospital deaths among cancer patients: A nationwide population-based cohort study. PLOS ONE, 15(4), e0232219.
https://doi.org/ 10.1371/journal.pone.0232219
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