| 摘要: | 背景：隨著人口老化，慢性病盛行率高，老人常於醫療院所接受無幫助侵入性檢查與治療。近年來政府將安寧理念推廣至非癌末期病人照顧，然而大多數非癌末期病人對安寧緩和療護的利用率仍偏低。
目的：本研究目的為瞭解長照機構老人照顧決策者對安寧緩和療護的知識與態度的現況，並探討其差異與影響。
方法：本研究採量性、橫斷式調查法(cross-sectional survey design)，以自擬問卷收集資料，選擇二家大型護理之家及一家區域醫院附設居家護理所老人之照顧決策者為研究對象，以方便取樣，自108年10月至109年1月收案。收案條件：(1)被照顧老人年齡須≧65歲，且入住護理之家或接受居家護理服務時間至少三個月；(2) 老人照顧決策者年齡≧20歲，能以中文進行溝通、無視力或聽力障礙；(3)為老人之主要照顧決策者。統計方式包括：獨立樣本t檢定(Independent t-test)、單因子變異數分析(one-way ANOVA)、皮爾森相關(Pearson correlation)、及多元（複）迴歸(Multiple Regression)。
結果：本研究共收集有效問卷共370份，護理之家221份，居家護理所149份。長照機構老人照顧決策者安寧緩和療護知識問卷整體平均得分為25.02分(SD=3.71)，態度問卷整體平均得分為83.44分(SD=11.59)。安寧緩和療護知識在年齡、教育程度、職業有顯著差異(p<0.001)，安寧緩和療護態度在教育程度、職業、宗教信仰、家庭經濟狀況、是否與被照顧老人討論過安寧緩和療護有顯著差異(p <0.05)。老人照顧決策者的安寧緩和療護知識與態度有正相關(r=.295)。被照顧老人為女性(β =-2.592，p<0.05)、共病指數分數高(β =-2.464，p<0.05)的老人照顧決策者安寧緩和療護態度較好；照顧決策者教育程度為大專/大學(β =2.001，p <0.001)、研究所(β =3.004，p <0.001)、職業為軍公教(β=1.874，p<0.001)，達統計顯著水準，可預測教育程度為大專/大學、研究所，職業為軍公教則安寧緩和療護知識較好；安寧緩和療護態度方面，研究所(β =6.514，p <0.05)、職業為軍公教(β =3.882，p <0.05)、家庭經濟狀況為中低/低收入戶(β =-6.202，p <0.05)、與被照顧老人討論安寧緩和療護(β =6.222，p <0.05)，達統計顯著水準，可預測教育程度為研究所、職業為軍公教、家庭經濟狀況為一般戶、與被照顧老人討論安寧緩和療護，較能接受安寧緩和療護。
結論：本研究結果在安寧緩和療護態度問卷「我贊成末期病人於家中/護理之家接受居家安寧緩和照護」得分最低，建議：1.醫療院所可協助加強大眾安寧緩和療護教育，對高風險的老人照顧決策者更應提早介入與說明安寧緩和療護；2.政策應加強推動以病人為中心的社區安寧緩和醫療照護網絡，鼓勵社區型醫療院所、長照機構參與提供安寧緩和照護，讓老人照顧決策者於機構或居家照顧老人時，相關知識與技巧能獲得足夠的支持，被照顧老人亦能獲得連續性的安寧緩和照護，以增加末期病人於機構或居家接受居家安寧緩和照護之意願。
Background: As the ageing population increases and the disabled population rises, the government has been promoting the concept of palliative care to non-cancerous patients in order to reduce the end-of-life patients. However, the utilization rate of palliative care is still low.
Objectives: This study aims to understand the current status of long term care decision-makers’ knowledge of and attitudes toward palliative care, and to explore the differences and influence factors .
Methods: This qualitative cross-sectional survey designed study performed self-developed questionnaire survey on decision makers in two large nursing homes and a homecare center affiliated with regional hospital from October, 2019 to January, 2020. Criteria of enrollment include: (1) Care recipient who was≧65 years old,use long term care services was at least three months; (2)Care decision maker who was ≧20 years old.
Results: A total of 370 valid questionnaires were collected,There were significant differences in age, education level, and occupation in the knowledge of palliative care (p <0.001), and significant differences the education level, occupation, religion, economics ,and discussed tranquility and palliative care with the elderly in the attitude of palliative care (p <0.05). There was a low correlation between the knowledge and attitudes in care decision makers toward palliative care (r=0.295).The gender (p<0.05) and the Charlson comorbidity index (p<0.05) of care recipient were the significant factors influencing the attitude of care decision makers toward palliative care; the education level of the care decision makers included junior college /University (p<0.001), master (p <0.001), occupation of these included public employees (p <0.001),which are statistically significant. The result shows that higher the education level of care decision makers, better the knowledge in palliative care they had. Moreover, master(p <0.001),public employees (p<0.05) and low- and middle-income households (p<0.05) , discussed tranquility and palliative care with the elderly(p <0.05) ,also had significant impact on attitudes toward palliative care. It shows that public employees,and those with general household were more likely to accept palliative care.
Conclusions: 1.Medical institutions should help strengthen public hospice and palliative care education, and should also intervene early and explain the hospice and palliative care to high-risk elderly care decision makers;2.Government policy should aim to strengthen the promotion of patient-centered community hospice and palliative medical care and medical care network. Moreover, it should encourage community-based medical institutions and long-term care institutions to participate in providing hospice and palliative care service. Thus, not only the elderly care decision-makers can obtain sufficient support of relevant knowledge and skills while caring the elders in institutions or at home, but the elders can also receive continuous hospice and palliative care which increase the willingness of end-stage patients to receive hospice home care and palliative care in institutions or at home. |
