臺灣博碩士論文加值系統

目的:末期病人在面臨營養及水分供給方式的選擇時，希望能藉由醫病共享決策，來幫助病人在充分了解的狀況下，作出最適當的決策。方法:以結構式問卷進行調查，針對北部某區域教學醫院之安寧病房末期病人為研究對象，以立意抽樣的方式取得86份問卷，運用SPSS 22.0統計軟體為研究工具進行描述性統計和推論性統計。結果:109年1月至12月共86位病人，男性45人（52.3%）；年齡40-64歲52人(59.3%)。醫病共享決策說明時，參與決策說明病人與家人共同參與60人(69.8%)，而最後自己決定選擇進食方式42人(48.8%) ，人口學與自我效能決策 (M ± SD)國中(含)以下(38.92±3.11)、高中職畢(35.45±4.54)及大專(含)以上(37.90±4.12)，Scheffe法事後比較國中(含)以下自我效能決策顯著高於高中職畢，另營養缺失階段為惡病質前期(38.10±3.48)與惡病質(37.51±3.77)的受訪者，在決策自我效能得分上顯著高於嚴重惡病質(34.95±5.59)的受訪者。結論:在SDM後對能提升醫療決策相關知識，有助於決策。對於末期病人而言，SDM若能更早介入且由病人自己進行決策，以病人的意願、自我照顧能力及生活品質為重要的考量，更具有效果性，建議針對這類型病人，應更積極於早期介入SDM，讓病人在此過程中獲得最佳的醫療資訊與判斷能力，做出最佳的決策。

Purpose:When faced with the choice of whether to administer nutrition and water supply -to end-stage, they wish to adopt Shared Decision Making (SDM ) to help patients, under a well informed situation, in making their most appropriate decisions. Method: A structured questionnaire was used to conduct a survey, targeting the patients at the hospice care of a northern region university hospital as the research object, and obtained 86 questionnaires through purposive sampling, while using SPSS 22.0 statistical software as a research tool, in reaching a descriptive and inferential statistical result. Results: From January to December, 109, there were 86 patients in the study, in which 45 were males (52.3%); 52 people aged 40 - 64 (59.3%). When sharing SDM explanation, 60 (69.8%) people were with patient and family jointly participated SDM, out of which 42 people (48.8%) choose to continue to receiving food. Demographics and self-efficacy decision-making (M ± SD) ) , with middle school education and below (38.92 ± 3.11), with high school degree (35.45 ± 4.54) and college degree or above (37.90 ± 4.12). Scheffe method is significantly higher than that of junior high school and below self-efficacy decision-making, and nutritional deficiency Respondents with pre-cachexia (38.10±3.48) and cachexia (37.51±3.77) have significantly higher decision-making self-efficacy scores than those with severe cachexia (34.95±5.59).Conclusions:After the SDM, the improvement of decision-making related knowledge can help decision-making. It is most effective for terminally ill patients if there is an early introduction of SDM with assessments made based on patient's own well understanding of self care with consideration in quality of life. Active and early intervention in SDM is high recommended so that patients can obtain the best medical information to develop judgment ability in the process for the making the most appropriate decisions.

中文摘要 ………………………………………………………………………… Ⅰ
英文摘要 ………………………………………………………………………… Ⅱ
目錄 ………………………………………………………………………… Ⅲ
表目錄 ………………………………………………………………………… Ⅴ
圖目錄 ………………………………………………………………………… Ⅵ
第一章 緒論 ……………………………………………………………………. 1
第一節 研究背景 ……………………………………………………………... 2
第二節 研究目的 ……………………………………………………………... 5
第三節 名詞界定 …………………………………………………………….. 6
第二章 文獻探討 …………………………………………………………….. 8
第一節 醫病共享決策 ………………………………………………………… 9
第二節 末期病人人工營養和水份治療 ……………………………................ 15
第三節醫病共享決策之評估工具 ……………………………………………. 17
第三章 研究方法 ……………………………………………………………... 24
第一節 研究架構與設計 ………………………………………………….. 24
第二節 研究對象及樣本數 ………………………………………………….. 25
第三節 研究工具 ……………………………………....................................... 26
第四節 研究流程 ……………………………………....................................... 28
第五節 資料統計分析方法 ………………………………………………….. 30
第四章 研究結果與討論 ………………………………………………….. 31
第一節 研究對象之人口學變項 ……………………………........................... 31
第二節 研究對象之人口學變項與自我效能決策、決策程度與決策滿意度之關聯性分析 …34
第三節 研究對象決策的自我效能決策、決策程度與決策滿意度結果 …... 38
第四節 研究對象的自我效能決策、決策程度與決策滿意度之相關性 …... 42
第五節 影響研究對象之決策滿意度的相關性 ……………………………… 43
第五章 結論與建議 ………………………………………………....................... 47
第一節 研究結論 ………………………………………………...................... 47
第二節 研究限制 ………………………………………………....................... 49
第三節 研究建議 ………………………………………………...................... 50
參考文獻 ………………………………………………………………………….. 51
附錄 ………………………………………………………………………….. 57

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