社區高齡者預立醫療自主計畫之介入與推展

Implementing and Promoting Advance Care Planning for Community Older Adults

預立醫療自主計畫（advance care planning, ACP）在臺灣的基層醫療體系是一個新興的議題。雖然過去研究顯示，不論在醫院臨床或在社區醫療機構，ACP的介入對不同族群皆有成效，但臺灣社區高齡者，討論ACP的機會或簽署書面預立醫療指示的比率依然很低。本文從社區衛生護理的角度出發，先探討國內外ACP在社區的發展與現況，再介紹介入的模式與相關資源。期待未來在醫療團隊人員的引導下，更多社區高齡者能有機會討論ACP，進而提升其生命末期的生活品質。

Advance care planning (ACP) is an emerging issue in the primary care system of Taiwan. Previous studies have attributed benefits to various types of ACP in diverse ranges of healthcare settings and populations. However, few older adults in Taiwan have had the opportunity to discuss ACP or to complete their advance directives. The present article takes the perspective of community health nursing to describe the international development and current status of ACP in the community in Taiwan. Furthermore, the intervention models and available resources of ACP are described. We look forward to healthcare professionals using ACP to assist greater numbers of community older adults, thus enhancing their terminal-stage quality of life.