癌症病人對預立醫療照護諮商之需要

癌症位居全球第二死因，對預立醫療照護諮商（advance care planning，ACP）有高度需要。ACP動態循環溝通過程包含評估、提供資訊、討論與追蹤確認四項要素，亦需敏察身心情緒狀態與提供關懷。本文旨在運用系統性質性文獻回顧統整分析ACP之執行內涵，透過病人視野與經驗，瞭解癌症病人對ACP之需要，並提供臨床應用建議。於Embase、PubMed、CINAHL電子資料庫，使用癌症病人、需要、經驗、喜好、預立醫療照護諮商、預立醫療決定、生預囑、病人自決等關鍵字，搜尋2018年8月前發表之文獻，共5篇具品質且符合條件之質性研究。癌症病人需要正確的ACP資訊與認知、關照情緒及自我調適因應、親善信任關係、維持希望、未來照護及決策資訊、表達想法、個別性及偏好被尊重、家人或重要他人知曉意願、手冊輔助、書面紀錄、確認意願是否改變及守護承諾。 Cancer is the second highest cause of death worldwide and constitutes a high need for advance care planning (ACP). The ACP dynamic circular communication process includes assessment, provision of information, discussion and follow-up of the four elements, and should incorporate awareness of patients' physical and emotional state and provide support. In this article we used systematic literature review to integrate and analyze the implementation of ACP, and focusing on patients' perspectives and experiences to understand cancer patients' needs for ACP and give recommendations for clinical applications. All literature published before August 2018 in the electronic databases Embase, PubMed and CINAHL was searched using the following key words: cancer patient, needs, experience, preference, advance care planning, advance directive, living will, and patient self-determination. A total of 5 qualified qualitative research publications met the criteria. Cancer patients need accurate information and knowledge about ACP, emotional support and self-adjustment coping skills, a rapport and trust relationship, maintenance of hope, future care and decision information, an opportunity to express thoughts, respect for their individuality and preference, family members or significant others who are aware of patient's wishes, handbook-guided counseling, written records, confirmation whether wishes have changed and fulfilling advance directive.