桃園某地區醫院安寧病房住院病人的服務分析

Service Analysis of Hospitalized Patients in the Hospice Ward at a District Hospital of TaoyuanTaoyuan

背景：國內目前有關使用安寧療護病人症狀分佈文獻仍較為匱乏，自2004 年桃園某地區醫院設立安寧病房以來，累積不少臨床照護實務經驗。因此，本研究旨在分析本院安寧病房五年期間第一次住院病人的人口學及臨床特性，希望本研究成果能作為改善國內安寧療護之參考。
方法：本研究為次級資料分析，使用2005 年1 月至2009 年12 月期間，第一次入住桃園某地區醫院安寧病房病人的住院資料(n = 1,025)，以SPSS17.0 進行描述性資料分析。
結果：此研究顯示病人平均年齡64.13 歲，男病人居多(56.59 %)，平均住院天數11.75 天。前三種常見的疾病依序為肺癌、結腸直腸癌及肝癌，常見三大症狀依序為口乾、食慾差及疲倦，平均症狀數為9.87。出院原因中50.9% 病人在院內往生， 33.1% 病人彌留返家死亡，及13.1% 病人病情穩定出院。
結論及建議：第一次入住安寧病房病人具有多重症狀，且過半數病人於轉介7 天內死亡，使得安寧療護團隊不易在有限時間進行末期病人的身心靈症狀評估及處置，以達成緩和療護的目標。未來須進一步研究如何在有限時間做好身心靈症狀評估及處置，以改善病人使用安寧療護的品質，並達到善終的機會。另於實務上仍需讓民眾及健康照護專業人員深入了解安寧病房的全人、全家、全程及全隊特色及功能，期待末期病人能及早接受身心靈症狀之評估和處置。

Background: The patterns of symptoms among patients admitted to the hospice care ward are areas of limited research. The district hospital at Taoyuan has set the hospice care ward since 2004 and accumulated clinical practice experience. Thus, the aim of this study was to analyze the demographic and clinical characteristics in patients with the first hospitalization of the hospice care ward within five years.
Methods: This was a secondary data analysis using patients’ first hospitalization of the hospice care ward data (n = 1,025) between 2005 and 2009 in the district hospital at Taoyuan. The data was analyzed using SPSS 17.0 for the descriptive statistic.
Results: The study showed that the average of patients’ age was 64.13 years and the majority was males (56.59%). The average length of stay was 11.75 days. Lung, colorectal, and liver cancer were three most common cancers. The three most common symptoms were dry mouth, poor appetite, and fatigue. The average number of symptoms was 9.87. The reasons for discharge were patients died eath in the hospital (50.9%), being discharged and patients died at home (33.1%), and being discharge with stable disease (13.1%).
Conclusions: The patients of hospice care ward have multiple symptoms. More than half of the patients died within seven days after transferring to the ward. Thus, it is difficult for the hospice care team to fully evaluate and manage patient’s symptoms and achieve the goal of palliative care. Future work is needed to address the issues of how to improve the quality of holistic hospice care.