某區域醫院住院癌症末期病患安寧照會報告

A report of The Hospice Consultation on Cancer Inpatients at a Regional Hospital

本研究探討某區域醫院2006及2007年間安寧照會的實施情形，包括照會服務涵蓋率、個別醫師收案率與照會率、照會病患的基本人口學及癌症相關資料、照會原因與科別、照會時機。研究期間總共有187位住院癌症病患死亡，其中 61位曾接受過安寧照會，安寧服務涵蓋率為32.6 %。收治住院癌症病患的主治醫師編碼為A~R,大多數病患是由A(31.6%)、B(7.5%)、C(8.0%)、D(9.6%)及E(27.3%)照顧；醫師個別的會診率為A (23%)、B (4.9%)、C( 8.2%)、D (19.7%)及E( 14.8%)。接受過安寧照會的病患，男性佔32名，女性佔29名，平均年齡66歲，原發腫瘤以肝癌、大腸直腸癌、肺癌為主。照會安寧療護最常見的原因為疼痛控制(63.9 %)，其次為安寧療護諮詢(19.7 %)、居家照護(9.8 %)。最常提出照會的科別為肝膽胃腸科( 36.1 %)、大腸直腸科(19.7 %)、胸腔科(14.8%)。55.7 %在照會後不到1個月即死亡，顯示照會時機大多過晚。此住院安寧照會服務模式，在無安寧病房的區域醫院中，雖然面對著困難與挑戰，不失為經濟有效提供安寧照顧的方式之一。

The study analyzed the results of hospice consultation in cancer inpatients who died at a regional hospital over a 2- year period (2006 and 2007). Analyzed factors included the rate of hospice consultation coverage, percentage of patients cared for by individual attending doctors, rate of referral, patient and and cancer-related data, reasons for referral, the referring departments and timing of the referral. In this study, there were 187cancer inpatients who died, of which 61 (32 men, 29 women, average age 66 years) received hospice consultation. The coverage rate was 32.6%. More effort is needed to provide hospice care to 50% of cancer patients, which is the goal of the National Cancer Strategy of Taiwan. The levels of the attending doctors in charge of the cancer inpatients ranged from V1 to V18. Most patients were cared by V5 (9.6%), V6 (27.3%), V8 (31.6%), V9 (7.5%) or V12 (8.0%) doctors.However, the individual referral rate did not correspond with the care rate. The most common primary tumors were hepatoma, colon-rectal cancer and lung cancer. The most common reasons for consulting hospice services were pain control (63.9%), hospice consultation (19.7%) and transfer to home care (9.8%). Most of these patients were referred from the departments of hepato-gastroenterology (34.4%), colon and rectal surgery(21.3%) and respiratory and thoracic medicine (13.1%).One month after consultation, 55.7% had died This indicates that the referral timing was too late. The model of inpatient hospice consultation without back-up from a hospice ward faces difficulties and challenges. The result of this study provides data for hospitals to implement a hospice service model.