某區域醫院居家醫療個案簽署不施行心肺復甦術同意書之相關因子

Factors Associated with Do-Not-Resuscitate Consent among Home Care Patients in a Regional Hospital

目的：本文分析某區域醫院居家醫療之病人中，影響病人簽署不施行心肺復甦術同意書之相關因素。 方法：收集自2016年至2018年間居家醫療個案共454位，分析相關變項：個案之人口學特性，安寧緩和醫療相關疾病史、日常生活與認知功能狀態、社會支持、居家醫療照護。以逐步多變項邏輯斯迴歸分析。 結果：病人照護日數，每增加一日，簽署不施行心肺復甦術機會減少0.2%，勝算比為0.998 (95% CI 0.997-0.999)；病人有語言表達能力者會減少簽署不施行心肺復甦術的機會，勝算比為0.28 (95% CI 0.11-0.77)。有召開居家家庭溝通會議勝算比為29.78 (95% CI 15.60-56.83)，有癌症病史勝算比為4.93 (95% CI 2.05-11.90)，安寧緩和評分4分以上（包含已經死亡未評分）勝算比為2.64 (95% CI 1.45-4.79)，醫師具有安寧受訓證書勝算比為2.63 (95% CI 1.01-6.84)，以上四項因素皆可增加簽署不施行心肺復甦術同意書的機會。 結論：本研究發現影響居家醫療個案簽署不施行心肺復甦術同意書的相關因素包括：照護日數較長及病人有語言表達能力者皆會減少其簽署不施行心肺復甦術的機會。有癌症病史，醫師有接受安寧訓練，召開家庭溝通會議，安寧緩和評分4分以上（包含已經死亡未評分）等因素則會提高病人簽署不施行心肺復甦術的機會。這些研究結果將可做為照護居家醫療個案時的重要參考，因此建議醫療照護團隊在考量病人癌症病史及根據安寧緩和需求，適時提供不施行心肺復甦術之相關醫療資訊，並協助其召開家庭溝通會議，以增加個案及家屬簽署不施行心肺復甦術同意書的機會。

 

Purpose: The study aimed to identify the factors associated with Do-Not-Resuscitate consent among home care patients in a regional hospital. Methods: 454 patients receiving home medical care from the host regional hospital from 2016 to 2018 were recruited. Variables for analysis included demographic characteristics, palliativehospice care related non-cancer diseases, cancer history, activities of daily life, functional status, family support, and home medical care. Stepwise multivariable logistic regression was used to evaluate the factors associated with DNR consent. Results: As indicated by the results of stepwise multiple-logistic regression analysis, increase in the length of home medical care (OR 0.998, 95% CI 0.997-0.999) and no difficulty in verbal expression (OR 0.28, 95% CI 0.11-0.77) both decreased the chance of signing DNR consent. Other factors associated with DNR consent included family meeting (OR 29.78, 95% CI 15.60- 56.83), cancer history (OR 4.93, 95% CI 2.05-11.90), a hospice eligibility score of 4 points or higher (OR 2.64, 95% CI 1.45-4.79), and a doctor certified for palliative care (OR 2.63, 95% CI 1.01-6.84). Conclusion: The study revealed that cancer history, a doctor certified for palliative care, family meeting, and a hospice eligibility score of 4 points or higher tended to increase the chance of signing DNR consent, whereas increase in the length of home medical care and no difficulty in verbal expression were likely to reduce the chance. The findings suggest that medical home care team should provide its patients with DNR-related information as early as possible so as to facilitate a family meeting for increasing the chance of signing DNR consent.