非癌病患接受安寧共同照護結果之探討

The Study of Palliative Shared-care for Non-cancer Patients

本研究旨在探討安寧共同照護介入對非癌末期病患照護結果的影響。本研究採回溯性資料調查法，以北部地區某一所醫療機構自2013年至2016年期間接受安寧共同照護的非癌末期病患為對象，共計300名有效樣本。經以描述性統計、卡方同質性考驗以及多變項羅吉斯迴歸的統計分析後，所得研究結果如下：（一）有提供家屬靈性宗教需求照護的安寧共同照護，相對於無提供照護者，在結案後病患有顯著較高的傾向會選擇不進行急救（p＝.011）、較不會進入加護病房（p＝.014），以及有較高的可能會撤除氣管內管（p＝.007）。（二）有協助病患營養與水分取捨的安寧共同照護，相對於無協助者，在結案後病患有顯著較高的傾向會選擇不進行急救（p＝.014）、較不會進入加護病房（p＝.015），以及有較高的可能會撤除氣管內管（p＝.001）。（三）有協助病患死亡準備的安寧共同照護，相對於無協助者，在結案後病患有顯著較高的傾向會選擇不進入加護病房（p＝.004）。（四）有協助病患藥物取捨的安寧共同照護，相較於無協助者，在結案後病患有顯著較高的傾向會選擇撤除氣管內管（p＝.016）。結論：安寧共同照護對家屬所提供的靈性宗教需求照護，以及協助病患營養與水分的取捨，能有效讓病患在安寧共同照護後傾向不進行多餘的治療或急救。

The main purposes of this study were to identify the hospice shared-care with non-cancer terminal patients, and to analyze how the related factors led to the outcomes of hospice shared-care. The non-cancer terminal patients were adopted in a hospital in the northern region of Taiwan, and there were 300 valid samples for this study from 2013 to 2016 by retrospective investigation. The collected data were analyzed by descriptive statistics, chi-square test of homogeneity and logistic regression analysis. The findings of this study were as follows. First, compared with the palliative shared-care with religious and spiritual care to patients' families and palliative shared-care with no religious and spiritual care, the patients with religious and spiritual care didn't prefer receiving emergency (p =.011), entering in intensive care unit (p =.014), and having endotracheal tube reversing after palliative shared-care (p =.007). Second, compared with the palliative shared-care with help on patients' trade-off nutritious and liquid intake and palliative shared-care with no help for patients, the patients with such help didn't prefer receiving emergency (p =.014), entering in intensive care unit (p =.015), and having endotracheal tube reversing after palliative shared-care (p =.001). Third, compared with the palliative shared-care with help on patients preparing for facing death and palliative shared-care with no help for patients, the patients with such help didn't prefer entering in intensive care unit (p =.004). Fourth, compared with the palliative shared-care with help on patients trade-off medicine intake and palliative shared-care with no help for patients, the patients with such help didn't prefer endotracheal tube reversing after palliative shared-care (p =.016). To conclude, the palliative shared-care with religious and spiritual care to patients' families and help on patients' trade-off nutritious and liquid intake could avoid the possibility of patients receiving unnecessary treatments or emergency after palliative shared-care.