探討衛教介入對社區長者預立醫療照護諮商知識與態度之成效

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題名:	探討衛教介入對社區長者預立醫療照護諮商知識與態度之成效 Exploring the Effectiveness of Health Education Intervention on the Knowledge and Attitudes of Advance Care Planning Consultations for the Elderly in the Community
作者:	歐建利 Ou, Chien-Li
貢獻者:	長期照護碩士學位學程林恭宏
關鍵詞:	預立醫療照護諮商;預立醫療決定;病人自主權利;社區長者 Advance care planning;Advance Decision;patient autonomy law;community elders
日期:	2021-12-30
上傳時間:	2022-08-05 10:19:26 (UTC+8)
摘要:	研究背景：隨著醫療科技的進步，許多老年人及末期病人因過多無效的醫療的介入，生命被無意義的延長且缺乏品質的老年生活，帶給長者及其家人莫大的壓力，同時也形成社會的負擔。台灣在自2019年實施病人自主權利法至今，大多於急性醫療院所推廣，相較於社區長者接受到的相關資訊也較少。預立醫療照護諮商可以讓社區長者在知情的情況下提前選擇符合自己價值觀的醫療照護方式，符合個人價值觀與偏好，為自己生命末期的照護做出重要的決定。因此，透過良好的溝通，可協助社區長者提升自主與自決權力，預先為未來醫療照護做規劃，做出適切的選擇，提升其生命尊嚴及品質。目的：瞭解社區長者對預立醫療照護諮商知識與態度的現況，並透過預立醫療照護諮商的衛教介入，提升其知識與態度之成效。方法：本研究為量性研究，以自擬問卷收集資料，兩組前後測研究設計，以方便取樣招募65歲社區長者，進行問卷前測，再以隨機分派的方式分為實驗組及控制組。實驗組給予兩次預立醫療照護諮商（Advance Care Planning, 以下簡稱ACP）衛教課程；控制組沒有參與衛教課程，只給予一張ACP宣傳單張。試驗結束後，兩組再進行問卷的後測。以描述性統計分析社區長者之人口學屬性；以獨立樣本t檢定（Independent-Sample- t test）分析衛教介入前後實驗組與控制組兩組之成效差異。結果：共61位社區長者完成本研究，其中實驗組28位（平均年齡74.2±8.6；男性佔46.4%），控制組33位（平均年齡81.2±9.8；男性佔54.1%）。ACP知識方面，實驗組與對照組之ACP知識分數前後測改變量間無顯著差異（獨立樣本t檢定之p值為0.668）。ACP態度方面，實驗組與對照組之ACP態度分數前後測改變量間達顯著差異（獨立樣本t檢定之p值為0.031）。結論：預立醫療照護諮商之衛教介入，有效提升社區長者之ACP態度，然而對於其ACP知識無顯著提升。未來研究需探討ACP知識無顯著提升之原因，並修改本研究之衛教介入教材、問卷或研究設計，以期有效提升社區長者ACP之知識與態度。 Background: As the advances of medical technology, life of the elderly and terminally-ill patients have been prolonged meaninglessly because of the futile medical treatments, and their lives are lacking of quality. The situation causes great pressure to the elderly and their families, and also causes a burden on society. Since Taiwan implemented the Patient Autonomous Rights Act in 2019, and it has been promoted in acute medical institutions more, than in the communities. The ACP allows elderly in the community to be informed in advance and able to choose medical treatments that consistent with their personal values and preferences. The important decisions are made by themselves for a good end. Therefore, through good communication, it can help the elderly in the community to enhance their power of autonomy and self-determination in planning in advance for future medical care and making appropriate choices to enhance their dignity and quality of life at the end of life. Purpose: To understand the current status of community elders’ knowledge and attitude toward advance care planning. And to understand whether community elders’ knowledge and attitudes towards ACP could be improved through the intervention of health education about advance care planning. Method: This is a quantitative study and data was collected by self-developed questionnaires. Two steps of pre- versus post- test research were designed and community elderly were recruited by convenience sampling and then randomly assigned to experimental group and control group. The experimental group was given two times ACP (Advance Care Planning, hereinafter referred to as ACP) health education courses, and the control group did not participate in the courses. After the intervention, the two groups conducted a post-test. Descriptive statistics was used to analyze the demographic attributes of the community elderly, and Independent t test was used to analyze the differences in effectiveness between the experimental and the control group before and after the intervention. Result: A total of sixty-one elderly completed this study. Twenty-eight elderly of them were in the experimental group (mean age: 74.2±8.6; male: 46.4%), and thirty-three of them were in the control group (mean age: 81.2±9.8; male: 54.1%). The change scores of ACP knowledge between the two groups were not significant (p value of independent t test: 0.668), but the change scores of ACP attitudes between the two groups were significant (p value of independent t test: 0.031). Conclusion: The intervention of ACP health education significantly improved the ACP attitudes in elderly, but not ACP knowledge. Our education materials warrant further studies to refine for improving the effects on the ACP knowledge.
描述:	碩士指導教授:林恭宏委員:林碧珠委員:陳淑如委員:林恭宏
資料類型:	thesis
顯示於類別:	[長期照護碩士學位學程] 博碩士論文

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