修習「家庭、社會與醫療」醫學生課程後對緩和醫療之認知

The Knowledge of Palliative Care Amongst Senior Medical Students Undertaking the Course “Family, Society and Medicine”

緩和醫療被認為是末期生命最適當的醫照護模試，然需大多數臨床醫師或醫學生的緩和醫療訓練機會，仍相當匱乏。本研究探討剛進入專業課程階段之醫學生對緩和醫療的認知程度，以及經過短期訓練課程後，學生在認知程度的改變狀況，藉此作為推展緩和醫療之醫學教育的參考。本研究採單組前後測準實驗設計，課程安排在醫學系五年級「家庭社會與醫療」的核心課程中，提供四小時的緩和醫療課程。針對整學年度參與的110位學生為對象，以「醫學生緩和醫療認知問卷」為測量工具來評估受訓學生對安寧緩和醫療的理念、基本處置與倫理困境思維的認知情形。結果顯示，學生對理念知識的回答正確率較高，課程前、後答對率平均分別為66.7%與75.8%，6題中有4題達顯著進步（p<0.05）。緩和醫療的基本處置知識正確率則較低，課程前、後答對率分別為55.4%與66.6%，9題中有5題達顯著進步（p<0.05）。另外，在四個癌末醫療常見倫理困境之決策認同度方面，課程前後皆以癌末病人可出院安排認同度最高（前4.48；後4.64，範圍1~5）。而癌末病人不必使用人工水分營養的論點，則不論課程前後，皆最不被學生所認同（3.13及3.54）。另外亦發現，在課程後倫理困境決策的態度與緩和醫療理念及處置知識相關性仍不高，除人工營養水分困境外，各項目之p值皆大於0.05。由本研究的結果可見，透過短期的緩和醫療課程訓練，可以增進專業課程醫學生對緩和醫療的整體認知，尤其在緩和醫療處置知識上的增進更為明顯。至於末期倫理課題的思維與啟發仍待進一步探討，以作為未來醫學教育相關課程安排之參考。

Hospice and palliative care has been recognized to be a better care modle for the terminally ill patients. However inadequate training for medical professionals and the lack of education for students have been noted in previous studies. The study was performed to investigate the knowledge of palliative care amongst the senior medical students (fifth grade in seven) undertaking the course “Family, Society and Medicine” and to compare the change after a short course including: one hour lecture, one hour patients visit, one hour journal reading and one hour discussion. Otherwise, the belief to the ethical dilemmas commonly occurred in palliative care was also investigated. A total of 110 medical students who received completed this course completed the questionnaire interview both in the time to pre and post course. The results showed that students got a higher accurate response rate in the philosophy of palliative care, which was improved significantly after this course (pre-test 66.7%vs. post-test 75.8%, p<0.001). However the accurate response rate in the management of palliative acre was lower, but still could be significantly improved after the course (pre-test 55.4%vs. post-test 66.6%, p<0.001). Otherwise, the medical students didn’t have the positive belief in “artificial nutrition and hydration always has no benefit for the terminal cancer patients” with a mean score of belief only 3.13 and 3.54 (pre-test and post-test, respectively; range 1-5). Furthermore, there was no significant correlation between knowledge of palliative care and belief of ethical decision, which implicated some other factors, may influence the belief in the decision-making for the ethical conditions. In conclusion, a short course of palliative care for students can improve significantly the knowledge of palliative care including philosophy and clinical management, and the sense of decision-making in ethical dilemma. To find other related factors influencing the belief of ethical dilemmas and incorporated those into further course of medical education are worthwhile efforts.