提升某醫院肺癌末期病人安寧療護涵蓋率

Increase the Provision Rate of Hospice-Palliative Care for Lung Cancer Patient in a Hospital

肺癌末期症狀嚴重影響病人生活品質，安寧緩和醫療推展有助症狀控制及提升末期生活品質。本院2015年1月至6月肺癌病人安寧療護涵蓋率僅10.9％。經分析主因：肺癌診療指引及個案管理師照護標準缺乏安寧療護轉介機制、團隊成員缺乏安寧療護訓練、電腦資訊系統未連結照會單等。解決方案：修訂肺癌診療指引及個案管理師照護標準，提供轉介安寧之評估內容，並進行團隊成員的安寧教育課程、落實安寧療護涵蓋率的品質監控、運用資訊協助安寧會診。結果顯示：專案實施後，肺癌病人安寧療護涵蓋率由原本10.9％提升至61.7％，落實安寧教育訓練及品質監控能增加肺癌末期病人安寧照護品質、有效提升安寧療護涵蓋率。 Symptoms of advanced lung cancer patients can seriously affect patients’ quality of life. Hospice-palliative care helps in controlling the symptoms and improves life quality among terminally ill patients. Data showed that the provision of hospice-palliative care for lung cancer patient from January to June, 2015 was only 10.9%. Analysis concluded that the low provision rate was caused by the lack of referral mechanism in lung cancer treatment and case manager care guideline, the lack of hospice training in lung cancer medical members, and that the computer information system was not connected to the notification forms. To address these issues, the following solutions were devised and implemented: revise lung cancer treatment and case manager care guideline to include referral mechanism, implement an evaluation for referral to hospice care, provide hospice training programs, implement quality control over provision of hospice care, and assist hospice care consultation with available resources. After the solutions were implementation, the provision rate of hospice-palliative care increased from 10.9% to 61.7%, which is a clear indication that the program can effectively increase both the quality and provision of hospice care for terminal lung cancer patients.