醫護人員對病人自主權利法之認知與態度──以中部某區域醫院為例

Knowledge and Attitudes of Healthcare Staff Regarding the Patient Self-Determination Act: A Case Study of a Regional Hospital in Central Taiwan

目的：本研究以中部某區域醫院醫護人員為對象，探討其對病人自主權利法之知識與態度。方法：本研究經醫院IRB委員會審查核准後，以電子問卷的方式回收305位醫護人員。問卷包括醫護人員基本特性、病人自主權利法知識與態度。統計分析方法包含敘述統計、t檢定與單因子變異數分析及多元複迴歸分析等。結果：研究結果顯示，醫護人員對病主法的規定並不熟悉，特別是病人擁有優先知情、選擇與決定權，病人簽署預立醫療決定的資格、啟動與執行的時機，醫療人員對於病人預立醫療決定的執行選擇權等項目，更是在病人自主權利法相關教育訓練中應該將加強的議題。醫護人員對於病人自主權利法之態度是正面的，但並未達到非常支持的程度，平均值較低的項目牽涉到醫護人員面對病人意願時是否遵行的價值衝突，另一個則是醫護人員很難單憑一位醫療委任代理人即執行病人預立醫療決定的困境。結論：醫院或政策單位都應該思考，如何將病人自主權利法相關教育訓練擴及到更廣泛的層面，讓第一線的醫護人員可以獲得足夠的教育訓練，並建立對病人自主權利法更加積極正面的態度，如此可以使得病人獲得更多的資訊與指引，往病人自主權利法期待的善終精神邁進。

Purposes: To explore the knowledge and attitudes of the healthcare staff of a regional hospital in central Taiwan regarding the Patient Self-Determination Act (PSDA). Methods: After the study was approved by the IRB committee, the responses of 305 healthcare staff members were collected through electronic questionnaires. Information gathered through the questionnaire included the healthcare staff's personal characteristics, as well as their knowledge of and attitudes towards the PSDA. The statistical analysis methods, including descriptive statistics, the t-test, the one-way ANOVA, and multiple regression analysis, were employed. Results: The results showed that the healthcare staff were not familiar with the PSDA's regulations, especially with regard to patients' rights to informed consent, choice-making, and decision-making, whether a patient is eligible to sign an advance decision (AD) and when the AD should be activated and implemented, as well as the power that healthcare staff have in determining the implementation of the patient's AD. These are all important topics that should be reinforced in PSDA-related education and training. The healthcare staff's attitudes towards the PSDA were positive but did not reach a degree of high support. The responses with low mean values were related to value conflicts-healthcare staff were conflicted about whether to consider the patient's wishes or the difficulties faced by healthcare staff in implementing the patient's AD based on the words of a single health care agent. Conclusions: Hospitals and policymakers should consider ways to expand PSDA-related education and training to a more universal level, so that first-line healthcare staff can obtain sufficient education and training and develop a more positive attitude towards the PSDA. This would enable patients to access more information and guidance as well as push healthcare staff toward adopting a positive spirit for palliative care, as intended by the PSDA.