癌末期病人之照護體系－－台灣安寧和緩和醫療文獻之回顧

Care System for the End of Life in Cancer Patients--Literature Review of Hospice and Palliative Care in Taiwan

癌末病人日益增多，照顧癌末病人也成為醫療體系中不可欠缺的一部份。過去十多年來，國內有識之士，曾耗費過大量時間、經費及人力完成各類研究資料，其研究成果對未來本土化安寧緩和醫療工作推展將有極大助益。本研究即據此而進行國內安寧緩和醫療癌末照顧相關研究文獻之查證工作，希望提供國內進一步建立完整癌末照顧體系最有效率的努力方向及工作重點。本研究之方法為蒐集國內所有有關安寧緩和醫療癌末照顧之原著報告共58篇，並進行專家審閱工作，除提出一般量性及質性結果外，同時建立新的研究理論架構，依推展目標的分類，進一步提出評論及建議。結果顯示：有關文獻最早為1985年，其後數量有逐年增加之趨勢，其中以碩士論文最多(31.0%)，內容則側重心理層面(17.3%)，就類別而言則以實務性研究居多(51.7%)，研究方法則以量性研究最多(74.1%)，而取樣方式主要為非隨機抽樣法(82.8%)。至於質性結果則是將各文獻查證結果，依研究理論架構之項目分別列述，並提出建議。本研究結論為：提供有效及整體性之教育為台灣安寧緩和醫療推展之必要工作，本研究建議國內未來安寧緩和醫療工作推展及研究重點為：1.持續推展死亡教育及宣導安寧緩和醫療理念。2.持續探討本土化追求善終之道。3.適切地引進宗教力量於安寧緩和醫療工作。4.建立臨床工作之倫理困境指引。5.建立癌痛及常見症狀之照顧指引。6.發展國內癌末生活品質評量工具及臨床應用。7.增強心理調適及哀傷輔導之落實。8. 提昇社區醫療人員的癌末照顧能力與資源整合。9. 發掘與建立癌末照顧之人才資料庫與照顧團隊合作方式。10.安寧緩和醫療法儘速立法與落實。11.進行成本效益分析須包括生活品質與家庭社會成本。12.爭取合理健保給付。13. 普遍施行服務品質稽核工具。14.安寧緩和醫療納入醫學教育必修課程。15.生命教育納入國中小學之正式課程。

There is a tendency of increasing terminal cancer patients in most of the countries. It is well recognized that care of terminal cancer patients will be the essential part of medical care system. In last decade, there were a number of research papers in Taiwan. These reports would make the future directions more clear in the development of hospice care. This study for literature review collected all the original papers in Taiwan and found 58 articles totally. The important findings of each paper were recorded by jury reviews. There was a tendency of increasing the number of papers year by year since 1985. Master thesis occupied mostly in these papers (31.0%). Emotional problems was most common (17.3%) for the content of researches. As for the types, research for clinical practice had the highest percentage (51.7%). Quantitative study was the commonest (74.1%) in methodology. And non-randomized sampling method was most often utilized (82.8%). The suggestions proposed according to the new established conceptual framework are including: 1) public education for thanatology and hospice care, 2) continue to find the way for good death, 3) recruit religious manpower into hospice care, 4) guideline for the clinical dilemmas, 5) guideline for pain and other symptoms control, 6) evaluation tool for quality of life, 7) promotion of the coping ability to the truth and bereavement care, 8) establish better community care, 9) multiprofessional practice in team work, 10) regulations and laws for palliative care,11) cost-benefit analysis which includes the life quality, 12) reasonable insurance payment, 13) useful tool for auditing quality of palliative care , 14) incorporation of hospice and palliative care to medical education, 15) death education since childhood.