預立醫療自主計畫對提升長期照護機構老人安寧療護、預立醫療指示知識及態度的成效初探

The Effects of the Advance Care Planning Program on Knowledge and Attitude of Hospice Care and Advanced Directives among Older Adults in a Long-term Care Facility: A Pilot Study

背景：老人處於疾病末期，若給予過多而無效的醫療處置，雖能延長生命，但卻嚴重影響其生活品質，不但為罹病的老人與家庭帶來莫大的痛苦與煎熬，浪費醫療資源，形成社會負擔。目前長期照護機構的住民多數對安寧療護及預立醫療指示不了解，鮮少探討預立醫療自主計畫對長期照護機構老人的成效。
目的：探討預立醫療自主計畫對機構老人於安寧療護、預立醫療指示認知及態度成效。
方法：此研究採單組前後測研究設計，以方便取樣選取某一長期照護機構25 位老人為研究對象，接受預立醫療自主計畫介入措施，包含以圓滿人生畫冊進行一小時個別生命回顧訪談及兩次30 分鐘安寧療護及預立醫療指示團體衛教，藉由「民眾對末期病人使用安寧療護認知與態度之調查」問卷進行前後測調查，評值此介入措施前後之安寧療護、預立醫療指示的知識與態度。
結果：機構老人於接受預立醫療自主計畫介入後，安寧療護及預立醫療指示知識平均分數由前測3.84(SD=1.95) 顯著地增至後測10.56(SD=5.64) (p<.001)，安寧療護態度平均分數由前測78.24(SD=6.96) 增至後測85.56(SD=6.83)，亦達顯著差異 (p=.001)。「預立安寧緩和意願書」及「預立不施予心肺復甦術」同意書簽署率提升至24%。
結論及建議：預立醫療自主計畫可顯著提升機構老人安寧療護、預立醫療指示知識及態度，故護理人員應主動積極宣導安寧療護及預立醫療指示，儘早透過預立醫療自主計畫，護理人員可協助老人表達對於生命末期醫療照護的看法，提升自主與自決權力，預先為末期醫療照護做規劃，於必要時做出合適選擇，減少不必要的醫療處置，提升其生命尊嚴及品質。

Background: Older adults can prolong their life by receiving excessive and ineffective medical treatments in their final stage of illnesses, but this can negatively affect their quality of life, increase pain and burden for older adults and family members, and increase medical expenses and social burden.
Aim: This study aimed to evaluate the effects of advance care planning program (ACP) on knowledge and attitude of hospice care and advanced directives among older adults in long-term care facilities.
Methods: This study used a one-group repeated measurement design. A convenience sample of 25 older adults in a long-term care facility was recruited. Subjects received the ACP program which consisted of a one-hour individual life review interview using an ACP handbook and two sessions of 30-minute group patient education on hospice care and advanced directives. All older adults received the baseline and posttest assessment using the Knowledge and Attitude scales of Hospice Care and Advanced Directives questionnaire.
Results: After receiving the ACP program, the average knowledge score of Hospice Care and Advanced Directives had increased significantly from 3.84 (SD=1.95) to 10.56 (SD=5.64). The average attitude score also increased from 78.24 (SD=6.96) to 85.56 (SD=6.83). The response rate for signing the Advanced Directives and Do-Not-Resuscitate Wills increased to 24%.
Conclusions: ACP program can improve the knowledge and attitude of hospice care and advanced directives among older adults in long-term care facilities. Nurses need to actively advocate information about hospice care and advanced directives. By implementing ACP program, nurses can help older adults express their views regarding medical treatments for end of life, enhance their autonomy and decisionmaking to plan for their end-of-life care in advance, avoid unwanted and ineffective medical treatments and improve their value and quality of life.