影響主要照護家屬讓癌症末期病患接受安寧緩和醫療因素之分析

Analysis of the Factors Affecting Acceptance of Hospice Palliative Care for Terminal Cancer Patients by Major Caregivers

安寧緩和醫療除提供癌症末期病患，全方位專業團隊的醫療照護，亦提供家屬的照護。以往針對病患本身的基本背景，身體情況，對癌末醫療的選擇及意願，照護場所的選擇等已有許多研究報告。本研究探討主要照護家屬對安寧緩和醫療的認知等各種變項與支持轉介病患至安寧緩和醫療病房的意願之間的相關性。研究樣本是台灣某醫學中心癌末病患之主要照護家屬，在原來之主治醫療團隊會診安寧緩和醫療團隊評估時，所做的訪視調查。再與其對安寧緩和醫療的意願之間做統計分析。研究結果顯示，病患的年齡、性別、診斷、罹病時間、主要照護家屬的性別、教育程度、宗教信仰、婚姻狀況、是否聽過安寧緩和醫療等變項與家屬是否希望病患接受安寧緩和療護之間，並無相關性（p>0.05）。病患的年齡、主要照護家屬與病患的親屬關、家屬是否了解或被告知病患在疾病無法治癒時的醫療處置方式、是否了解在病患病情危急時的醫療處置方式等因素，則與是否支持轉介病患至安寧緩和醫療病房有相關性（p<0.05）。由本研究可知：安寧緩和醫療團隊應與病患及家屬溝通，加強其對安寧緩和醫療的認知，期能提升其接受安寧緩和醫療的意願。

Hospice palliative care has provided complete and specialized medical services for terminal cancer patients and their families. In the past, there have been a number of reports that have discussed the characteristics of the patients under hospice care, the willingness of patients and their caregivers to accept hospice care, the health status of the patients, and the caring environment within the hospice. The aim of this study was to investigate factors affecting the willingness of major family caregivers to refer their family member for hospice palliative care. The study population was the major family caregivers of terminal cancer patients who were referred for hospice palliative care in a medical center in Taiwan. This study evaluated various factors related to hospice care, including patient gender, religious beliefs, marital status, level of education, personal health status, and awareness of hospice palliative care. We analyzed the correlations between the above factors and the willingness to enter into hospice palliative care. We demonstrated that all the basic characteristics listed above, as well as an understanding of hospice palliative care, did not correlate with one's willingness to receive hospice palliative care. On the contrary, the awareness of future management or plans during critical periods of illness had a significant correlation with the willingness to receive hospice palliative care. We therefore conclude that the palliative medical team should communicate closely with patients and their families and provide information regarding hospice palliative care. An increased awareness of palliative care may increase the possibility of receiving hospice palliative care. Hospice palliative care can therefore provide a high-quality of care for patients near the end of their life.