醫護人員預立醫囑知識與相關因素之探討

Medical Staffs’ Knowledge and Related Factors of Advance Directives

背景：近幾年醫界正努力推廣預立醫囑理念，但實際推展時仍遭遇許多阻礙，除訊息宣導不足外，醫護人員自身的簽署意願與預立醫囑知識亦可能影響預立醫囑推動。目的：探討醫護人員預立醫囑之知識及相關因素。方法：本研究為描述相關性研究。以南部某區域醫院之醫護人員為樣本來源，採分層隨機取樣依比例收案醫師30名、護理人員118名。以研究者自擬之基本屬性問卷、簽署意願及預立醫囑知識問卷作為研究工具，收集資料以描述性及推論性統計，含獨立樣本t檢定、單因子變異數分析及皮爾森積差相關進行分析。結果：本研究發現醫護人員預立醫囑知識在預立醫囑適用對象及未簽署預立醫囑者，他人是否有權為其撤除維生治療兩題項認知最不足。在簽署意願方面，僅2％為已簽署者，而有意願簽署者佔76～78％，簽署原因在醫師方面以「讓生命末期能有較佳的生活品質」為多，護理人員則以「避免造成家人身心或經濟上的負擔」為主；不願簽署原因兩者皆以「未來的日子還離我太遠，我沒考慮這些」為最多。而護理人員年齡為其預立醫囑知識之相關因素。結論：本研究了解醫護人員預立醫囑認知不足處及實際簽署比例，此結果除建立本土性資料，並提供醫療機構在職教育課程規劃之參考。

Promoting the concept of advance directives has encountered many difficulties in practices. In addition to insufficient information, the medical staffs’ knowledge and willingness of advance directives may affect patients’decision of developing advance directives as well. The purpose of this study was to understand the medical staffs’ knowledge and related factors of advance directives. This was a descriptive correlational research that used stratified random sampling to collect 30 physicians and 118 nurses from a regional hospital in southern Taiwan. The questionnaire was newly developed that included basic demographics and the knowledge and willingness of advance directives. Data were analyzed by independent t test, one-way ANOVA, and Pearson correlation. The results showed that medical staffs had insufficient knowledge about the targeted patients to which the advance directives apply and did not have clear idea about whether others have the right to remove patient’s life-sustaining treatment under the situation when there were no advance directives. Only 2% of the medical staffs had completed advance directives, although 76-78% indicated their willingness to have one. To ensure the quality at end-of-life was the most common reason for physicians to complete the advance directives while avoiding burden to family was the most common reason for nurses. Both groups perceived this is a question in the unforeseeable future, which became the predominant barrier of completion. The study findings provide understanding of medical staffs’ knowledge of advance directives, which could be essential for developing education programs in the future.