臺灣社區安寧居家療護之現在與未來

The Present and Future of Community/Home-Based Palliative Care in Taiwan

臺灣安寧緩和療護政策自1995年至今已將邁入第25年，並於2000年成為亞洲第一個訂定安寧緩和醫療條例的國家。國人罹患非癌症末期病人逐年增加，卻鮮少接受安寧療護照顧。此外，在宅往生為多數民眾的意願，但許多人沒有機會完成這個想法。安寧療護體系應針對病人實際需求，提升照護的可近性與連續性。因此，臺大醫院金山分院自2012年起發展先驅性之社區安寧照護服務模式，而全民健保亦自2014年開始給付社區安寧照護。建立社區安寧照護體系希望能提升生命末期品質，讓末期病人能有機會在社區中接受照護與善終。推展社區居家安寧，護理師需具備出院準備需求評估，提升末期症狀照顧和溝通知能，整合社區資源，並成立區域支持網絡，以提供高品質末期照顧。

In Taiwan, the Department of Health (DOH) has implemented regulations and policies related to hospice and palliative care since 1995. Taiwan is the first country in Asia to have a Natural Death Act, promulgated in 2000. Although recognition of the need for palliative care in non-cancer terminally ill patients is increasing, at present, the needs of these patients are often not met. Moreover, while a majority of the population prefers to die at home, the percentage of patients who die in the home setting remains small. The palliative care system should be adjusted to improve the accessibility and continuity of care based on the needs of patients. Therefore, the Jin-Shan Branch of the National Taiwan University Hospital has run a pilot community palliative care service model since 2012. National Health Insurance reimbursement was introduced in 2014 for community-based palliative care services. Establishing a formal system of community-based palliative care should be encouraged in order to improve the quality of care at the end of life and to allow more patients to receive end-of-life care and die in their own communities. This system will require that skilled nurses provide discharge planning, symptoms control, end-of-life communications, social-resources integration, and social-support networks in order to achieve a high quality of end-of-life care.