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研究生:史海柔
研究生(外文):SHIH, HAI-JOU
論文名稱:預立醫療自主計畫網路資訊介入於癌症晚期病人醫療決策行為意向之成效
論文名稱(外文):Effects of Web-Based Advance Care Planning Information Intervention on Intentions for Medical Decision-Making Behavior Among Advanced Cancer Patients
指導教授:潘雪幸潘雪幸引用關係
指導教授(外文):PAN, HSUEH-HSING
口試委員:吳莉芬張平穎辜志弘高偉堯
口試委員(外文):WU, LI-FENCHANG PING-YINGCHIH-HUNG KUKAO, WEI-YAO
口試日期:2024-04-25
學位類別:碩士
校院名稱:國防醫學院
系所名稱:護理研究所
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:2024
畢業學年度:112
語文別:中文
論文頁數:239
中文關鍵詞:預立醫療自主計畫癌症晚期醫療決策行為意向
外文關鍵詞:Advance Care PlanningAdvanced CancerMedical Decision-making Behavior Intentions
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背景:癌症為十大死因之首,癌症晚期之病程進展可預測性高,在病人失去自主決策能力前依意願行預立醫療自主計畫(Advance Care Planning, ACP)並簽署預立醫療決定,能增進臨終照護品質,使病人獲得善終。現今網路科技進步,病人透過網路探索醫療照護資訊大幅增加,故透過ACP網路資訊介入癌症晚期病人,促進其了解醫療決策行為意向至關重要。

目的:本研究旨在探討ACP網路資訊介入於癌症晚期病人醫療決策行為意向之成效。

方法:採隨機對照試驗,於血液腫瘤科門診及病房以方便取樣招募18歲(含)以上癌症晚期對象,共收案110位。以塊狀隨機分派為實驗組及對照組各55位,實驗組以ACP網路資訊及病人自主權利法五折頁文宣介入,對照組則提供病人自主權利法五折頁文宣,並於介入前、後及介入後一週以生命支持偏好問卷、ACP知識量表、ACP態度量表、ACP決策平衡量表、ACP自我效能量表進行測量。統計方法包括平均值、標準差、次數分配及百分比等描述性統計;獨立樣本t檢定、卡方檢定、單因子變異數分析、廣義估計方程式等推論性統計,p<0.05為統計顯著意義。

結果:ACP網路資訊介入後(β<0.01, p<0.001) 比介入前醫療決策行為意向顯著提升,介入後一週(β=-0.60, p<0.001) 比介入前醫療決策行為意向顯著下降;紙本文宣介入後(β=0.02, p=0.313)及介入後一週(β=-0.15, p=0.232) 比介入前醫療決策行為意向皆無統計顯著差異;組別時間交互作用下,介入後比介入前醫療決策行為意向無統計顯著差異(β=-0.02, p=0.313),介入後一週比介入前醫療決策行為意向顯著下降(β=-0.45, p=0.032)。ACP知識於ACP網路資訊介入後(β=1.85, p<0.001)及介入後一週(β=1.57, p<0.001)比介入前皆顯著增加;紙本文宣介入後(β=2.31, p<0.001)及介入後一週(β=2.04, p<0.001)比介入前ACP知識皆顯著增加;組別時間交互作用下,介入後(β=-0.45, p=0.130)及介入後一週(β=-0.47, p=147)比介入前ACP知識皆無統計顯著差異。ACP態度於ACP網路資訊介入後(β=1.18, p=0.001)及介入後一週(β=3.78, p<0.001)比介入前皆顯著增加;紙本文宣介入後(β=0.75, p=0.012)及介入後一週(β=1.97, p<0.001)比介入前ACP態度皆顯著增加;組別時間交互作用下,介入後比介入前ACP態度無統計顯著差異(β=0.44, p=0.338),介入後一週比介入前ACP態度顯著增加(β=1.82, p=0.004)。ACP決策平衡於ACP網路資訊介入後比介入前ACP決策平衡無統計顯著差異(β=0.55, p=0.056),介入後一週比介入前ACP決策平衡顯著增加(β=5.14, p<0.001);紙本文宣介入後比介入前ACP決策平衡無統計顯著差異(β=0.35, p=0.329),介入後一週比介入前ACP決策平衡皆顯著增加(β=1.38, p=0.004);組別時間交互作用下,介入後比介入前ACP決策平衡無統計差異(β=0.20, p=0.660),介入後一週比介入前ACP決策平衡顯著增加(β=3.77, p<0.001)。ACP自我效能於ACP網路資訊介入後比介入前無統計顯著差異(β=0.18, p=0.354),介入後一週比介入前ACP自我效能顯著增加(β=3.90, p<0.001);紙本文宣介入後(β=0.65, p=0.006)及介入後一週(β=2.43, p<0.001)比介入前ACP自我效能皆顯著增加;組別時間交互作用下,介入後(β=-0.47, p=0.127)及介入後一週(β=1.46, p=0.138)比介入前ACP自我效能皆無統計顯著差異。醫療決策行為意向及ACP知識(p=0.502)、ACP態度(p=0.727)、ACP決策平衡(p=0.365)、ACP自我效能(p=0.283)間皆無統計顯著相關性。

結論與未來建議:ACP網路資訊介入癌症晚期病人能降低病人使用維生醫療之醫療決策行為意向,並增進病人對ACP之知識、態度、決策平衡及自我效能,因此,建議應增加ACP網路資訊使用之廣泛性。

關鍵字:預立醫療自主計畫、癌症晚期、醫療決策行為意向

Background: Cancer is a leading cause of death, and the progression of advanced cancer is highly predictable. Advance Care Planning (ACP), along with the signing of advance medical directives before patients lose their decision-making capacity, can enhance the quality of end-of-life care and facilitate peaceful passing for patients. With the advancement of internet technology, patients now have significantly increased access to healthcare information online. Thus, intervening with ACP internet information is crucial for patients with advanced cancer to promote their understanding of medical decision-making behaviors.

Objective: This study aimed to investigate the effectiveness of an ACP Internet information intervention on the medical decision-making behavioral intentions of patients with advanced cancer.

Methods: A randomized controlled trial was conducted, recruiting subjects aged 18 and above with advanced cancer from hematology-oncology outpatient clinics and wards using convenience sampling, with a total of 110 cases. The participants were randomly assigned to the experimental and control groups, each comprising 55 individuals. The experimental group received interventions involving ACP internet information and pamphlets on patient autonomy rights, whereas the control group received pamphlets on patient autonomy rights only. Measurements were conducted before and after the intervention, as well as one week after the intervention, using the Life Support Preferences Questionnaire, ACP Knowledge Scale, ACP Attitude Scale, ACP Decisional Balance Scale, and ACP Self-Efficacy Scale. The statistical methods included descriptive statistics, such as mean, standard deviation, frequency distribution, and percentage; and inferential statistics, such as independent samples t-test, chi-square test, one-way analysis of variance, and generalized estimating equations, with p < 0.05 indicating statistical significance.

Results: After ACP internet information intervention (β < 0.01, p < 0.001), medical decision-making behavior intentions significantly increased compared to before the intervention; however, a significant decrease was observed one week after the intervention(β = -0.60, p < 0.001); after paper-based pamphlet intervention (β = 0.02, p = 0.313) and one week after (β = -0.15, p = 0.232), no statistically significant differences were observed in medical decision-making behavior intentions compared to before the intervention; under the interaction between group and time, no statistically significant differences were observed between before and after the intervention (β = -0.02, p = 0.313); however, a significant decrease was observed one week after the intervention (β = -0.45, p = 0.032). ACP knowledge significantly increased after ACP internet information intervention (β = 1.85, p < 0.001) and one week after (β = 1.57, p < 0.001) compared to before; after paper-based pamphlet intervention (β = 2.31, p < 0.001) and one week after (β = 2.04, p < 0.001) compared to before; under the interaction between group and time, no statistically significant differences were found between after and before (β = -0.45, p = 0.130) and one week after and before (β = -0.47, p = 147). ACP attitude significantly increased after ACP internet information intervention (β = 1.18, p = 0.001) and one week after (β = 3.78, p <0.001) compared to before; after paper-based pamphlet intervention (β = 0.75, p = 0.012) and one week after (β = 1.97, p < 0.001) compared to before; under the interaction between group and time, no statistically significant differences were observed between after and before (β = 0.44, p = 0.338); however, a significant increase was observed one week after compared to before (β = 1.82, p = 0.004). ACP decisional balance presented no statistically significant differences after ACP internet information intervention compared to before (β = 0.55, p = 0.056); however, it significantly increased one week after compared to before (β = 5.14, p < 0.001); after paper-based pamphlet intervention displayed no statistically significant differences compared to before (β=0.35, p=0.329); however, it significantly increased one week after compared to before (β = 1.38, p = 0.004); under the interaction between group and time, no statistically significant differences were observed after compared to before (β = 0.20, p = 0.660), whereas, a significant increase was observed one week after compared to before (β = 3.77, p < 0.001). ACP self-efficacy displayed no statistically significant differences after ACP internet information intervention compared to before (β = 0.18, p = 0.354); however, it significantly increased one week after compared to before (β = 3.90, p < 0.001); after paper-based pamphlet intervention (β = 0.65, p = 0.006) and one week after (β = 2.43, p < 0.001) compared to before; under the interaction between group and time, no statistically significant differences were found after (β = -0.47, p = 0.127) and one week after (β = 1.46, p = 0.138) compared to before. No statistically significant correlations were found between medical decision-making behavioral intentions and ACP knowledge (p = 0.502), ACP attitude (p = 0.727), ACP decisional balance (p = 0.365), or ACP self-efficacy (p = 0.283).

Conclusion and Future Recommendations: An ACP Internet information intervention for patients with advanced cancer can reduce their intention to use life-sustaining medical care and improve their knowledge, attitudes, decisional balance, and self-efficacy regarding ACP. Therefore, expanding the use of ACP Internet information is recommended.

Keywords: advance care planning, advanced cancer, medical decision-making behavioral intentions

第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 5
第三節 研究問題 6
第二章 文獻查證 7
第一節 癌症晚期病人相關概念及定義 7
第二節 癌症晚期病人醫療決策行為意向 8
第三節 預立醫療自主計畫網路資訊介入相關概念 20
第四節 預立醫療自主計畫網絡資訊介入於癌症晚期病人醫療決策行為意向成效研究現況 30
第三章 概念架構 32
第一節 研究架構 32
第二節 研究假設 34
第三節 名詞定義 35
第四章 研究方法 38
第一節 研究設計 38
第二節 研究場所及研究對象 40
第三節 措施介入 42
第四節 研究工具及信效度檢定 43
第五節 研究步驟 51
第六節 資料處理及統計分析方法 54
第七節 研究倫理 58
第五章 研究結果 59
第一節 癌症晚期病人基本屬性分布 59
第二節 癌症晚期病人實驗組及對照組於介入前、後及介入後一週ACP知識、ACP態度、ACP決策平衡、ACP自我效能、醫療決策行為意向差異 64
第三節 ACP網路資訊介入於癌症晚期病人醫療決策行為意向之成效 73
第四節 ACP網路資訊介入對於癌症晚期病人ACP知識之成效 82
第五節 ACP網路資訊介入對於癌症晚期病人ACP態度之成效 91
第六節 ACP網路資訊介入對於癌症晚期病人ACP決策平衡之成效 102
第七節 ACP網路資訊介入對於癌症晚期病人ACP自我效能之成效 111
第八節 癌症晚期病人ACP知識、ACP態度、ACP決策平衡、ACP自我效能與醫療決策行為意向之關係及相關因素 120
第六章 討論 126
第一節 ACP網路資訊介入癌症晚期患者醫療決策行為意向、ACP知識、ACP態度、ACP決策平衡、ACP自我效能之成效 126
第二節 癌症晚期病人醫療決策行為意向與ACP知識、ACP態度、ACP決策平衡、ACP自我效能之相關性 148
第七章 結論、限制與建議 152
第一節 結論 152
第二節 研究限制 155
第三節 建議 156
第八章 參考文獻 157
壹、英文文獻 157
貳、中文文獻 190

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