| 摘要: | 背景：全世界失智症人口逐年增加，依據2017年國際失智症協會資料，2017年全球失智症人口近5千萬人，為照顧失智症所付出的社會成本也日益龐大，影響層面除病人外，還包括失智者家庭的生活品質、工作表現、經濟負擔與身心壓力等。預立醫療照護計畫(Advance care planning)是一個持續討論的過程，與病人的家屬及醫療專業人士，討論關於個人偏好、價值觀、未來醫療期望和護理目標的決策，讓病人獲得最適切的醫療照護。但至今仍未有具實證基礎之系統性文獻回顧及統合分析探討失智症病人接受預立醫療照護計畫之成效。
目的：以系統性文獻回顧及統合分析探討失智症病人接受預立醫療照護計畫對於改善失智症病人及家屬的決策衝突、降低住院率及增加預立醫療指示(Advance directives)簽署率之成效。
方法：本研究以系統性文獻回顧的方式，使用10個中、英文電子資料庫(Cochrane Library、CINAHL、Medline OVID、PubMed、PsycINFO、Wed of Science、Embase、台灣博碩士論文網資料庫、華藝線上圖書館與中國期刊全文數據庫)，運用關鍵字(Dementia and Advance care planning)蒐集至2018年10月31日前之國內外以失智症為對象，預立醫療照護計畫為介入措施之隨機臨床試驗文獻，探討預立醫療照護計畫對失智症病人及家屬的決策衝突、降低住院率及預立醫療指示簽署率之成效，使用Comprehensive Meta-Analysis(CMA) Version 2軟體進行統合分析。
結果：搜尋得3739篇文獻，共有9篇文章符合收案條件，納入統合分析，結果顯示預立醫療照護計畫可以有效改善決策衝突(95% CI:-0.64~-0.071, p=.014)、增加預立醫療指示之簽署率(95% CI:1.180~2.025, p=.002)，然而對於降低住院率成效則未達顯著差異(95% CI:0.546~1.127, p=.189)。
結論：本研究推論失智症接受預立醫療照護計畫可以有效改善決策衝突及增加預立醫療指示簽署率。
Background: The number of people living with dementia worldwide has increased year by year. According to the 2017 International Association of Dementia, the global population of dementia is nearly 50 million in 2017. The societal cost of dementia is also growing. A diagnosis of dementia not only impacts a person’s life but also affects family caregivers” quality of life, work performance and causes financial, physical, and emotional burdens. Advance care planning (ACP) is an ongoing process of discussing decisions about personal preferences, values, future medical expectations and care goals with the patient's family and medical professionals to make the patient's treatment optimal. Unfortunately, there is no systematic review and meta-analysis examining the effects of ACP for people with dementia.
Objective: To evaluate the effects of ACP for dementia patients in improving decision-making conflicts of dementia patients and their families, reducing the hospitalization rate and improving the signing rate of advance directives.
Methods: We performed a systematic review and meta-analysis of randomized clinical trials that investigated ACP for dementia patients. Ten Chinese and English electronic databases (Cochrane Library, CINAHL, Medline OVID, PubMed, PsycINFO, Wed of Science, Embase, Airity Library, Taiwan Master's Thesis Database, Huayi Online Library and China Journal Full-text Database) were searched for articles published before October 31, 2018 -by using key words: dementia and advance care planning. The effects of ACP on decision-making conflicts between dementia patients and their families, the hospitalization rates, and the signing rate of advance directives were estimated. Comprehensive Meta-Analysis Version 2 software was used for meta-analysis.
Results: Of 3,739 screened studies, 9 met the inclusion criteria and were included in the analysis. The results showed that ACP improved decision-making conflicts (95% CI: -0.64~-0.071, p=.014) and increased the signing rate of advance directives (95% CI: 1.180~2.025, p=.002). However, no significant effects in reducing the hospitalization rate (95% CI: 0.546~1.127, p=.189) was found.
Conclusion: This study infers that ACP for people with dementia can effectively improve decision-making conflicts and increase the signing rate of advance directives. |
