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研究生:官佳葳
研究生(外文):KUAN, CHIA-WEI
論文名稱:安寧緩和就醫提問單的發展與前驅測試
論文名稱(外文):Development and Pilot-test of a Question Prompt List for Hospice Palliative Care
指導教授:魏米秀魏米秀引用關係
指導教授(外文):WEI, MI-HSIU
口試委員:林季緯謝至鎠
口試委員(外文):LIN, CHI-WEIHSIEH, JYH-GANG
口試日期:2023-05-03
學位類別:碩士
校院名稱:慈濟大學
系所名稱:傳播學系碩士班
學門:教育學門
學類:其他教育學類
論文種類:學術論文
論文出版年:2023
畢業學年度:111
語文別:中文
論文頁數:99
中文關鍵詞:安寧緩和就醫提問單醫病溝通以病人為中心健康識能
外文關鍵詞:hospice palliative carequestion prompt listphysician-patient communicationpatient-centerednesshealth literacy
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進入到安寧緩和醫療的病人和家屬通常會有許多的疑問,但有許多的因素導致他們不知道如何向醫療人員討論。就醫提問單(以下簡稱QPL),是個簡便有效的溝通工具,可以協助病人、家屬和醫療人員促進討論。本研究旨在發展適用於安寧緩和情境下的QPL,並進行前驅測試瞭解病人或家屬使用成效。
研究方法採用混合研究法,共分成二階段,第一階段向4位家屬和6位醫療人員進行半結構式個別訪談與焦點團體訪談,確認適合納入QPL草稿的問題,再由相關領域專家進行審查,確認安寧緩和提問單內容,共7個類別、26個問題。第二階段於2022年12月至2023年3月在東部某醫院之安寧病房以方便取樣招募23位病人和家屬,進行QPL介入單組前後測前驅測試。以無母數統計方法進行統計檢定。
研究結果顯示在使用QPL後,安寧緩和自覺瞭解度(p=.001)、與醫療人員互動自我效能(p=0.18)、以病人為中心之照護感受(p=.037)和前測相比有提升者顯著比未提升者多;決策控制偏好在QPL使用前後沒有分佈上的差異。病人和家屬對使用QPL的感受,量性問卷結果對QPL的感受是相當正向的(M=4.33; SD=0.53);質性部分,病人和家屬指出使用QPL能幫助他們減少不安的情緒、提供思考提問的方向、讓其更認識安寧緩和。
QPL的介入提升了病人和家屬對安寧緩和的瞭解度、與醫療人員的溝通自我效能、以病人為中心的感知,並可讓病人和家屬更加瞭解自己的狀況,主動向醫療人員提出關心的議題,故在臨床實務上可使用QPL做為安寧緩和中醫病溝通的輔助工具,協肋病人和家屬在醫療過程中參與的主動性。建議未來可以針對QPL的使用成效做進一步研究。

Question Prompt List (QPL) is a simple and effective communication tool that can assist patients and family members in discussions with healthcare professionals. Patients and family members usually have many questions when they get into hospice palliative care (PC) but may not know how to discuss them with healthcare professionals. This study aimed to develop a QPL for palliative care and conduct a pilot test to determine its effectiveness and perceived usability from the patients and family members.
A mixed-methods design was used in this study, consisting of two phases. In the first phase, semi-structured individual interviews with four family members and focus group interviews with six healthcare professionals were conducted to confirm appropriate questions to include in the QPL draft. The content of the QPL, consisting of 7 categories and 26 questions, was then reviewed by relevant discipline experts. The second phase was a pre-post test of the QPL intervention pilot study conducted from December 2022 to March 2023. Twenty-three patients and family carers were recruited through convenience sampling from the palliative care unit of a hospital in Hualien.
The results showed that after using the QPL, there was a significant improvement in patients' and family carers' perceived understanding of palliative care (p=.001), perceived efficacy in physician patient interactions (p=0.18), and perceived patient-centered care (p=.037) compared to pre-test, all of which reached statistical significance. There was no difference in the control preference role before and after using the QPL. Patients and family carers agreed that the QPL was helpful for them (M=4.33; SD=0.53). Most participants felt that using QPL helped them to reduce their anxiety, provide an overview and prepare for what was ahead, and improve their understanding of palliative care.
The QPL intervention can improve patients' and family carers' understanding of palliative care, communication self-efficacy with healthcare professionals, and patient-centered perception. It can also help patients and family carers better understand their own conditions and proactively raise concerns with healthcare professionals. Therefore, in clinical practice, QPL can be a supportive communication tool for patients and healthcare professionals in palliative care, facilitating patient and family involvement in the healthcare process. Future research is needed for its effectiveness and adoption.
中文摘要 i
英文摘要 ii
目錄 iv
圖目錄 vi
表目錄 vii
第一章 緒論 1
第一節 研究背景和動機 1
第二節 研究目的 2
第二章 文獻探討 4
第一節 安寧緩和醫療 4
第二節 民眾在安寧緩和醫療中可能的困難 5
第三節 就醫提問單 10
第四節 就醫提問單在安寧緩和臨床醫療的應用 14
第三章 研究方法 29
第一節 研究架構 29
第二節 研究步驟 30
第三節 發展安寧緩和提問單 30
第四節 安寧緩和提問單介入測試 34
第四章 研究結果 42
第一節 安寧緩和提問單發展 42
第二節 安寧緩和提問單介入測試 49
第五章 討論與結論 68
第一節 討論 68
第二節 研究限制 71
第三節 建議 71
第四節 結論 72
參考文獻 73
附錄 80
附錄一、安寧緩和提問單草稿內容 80
附錄二、專家效度名單 82
附錄三、前測問卷 83
附錄四、後測問卷 89
附件五、研究計畫許可書 95
附件六、研究計畫變更許可書 97
附錄七、安寧緩和提問單三折頁 98


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