台灣安寧緩和醫療研究之挑戰

Challenge of Research in Palliative Care in Taiwan

安寧緩和醫療的推動在過去十年中，在一群充滿熱忱及使命感之專業人員的努力下，安寧緩和醫療對末期病人照護品質的提升及臨終病人尊嚴的貢獻已逐漸受到醫療團隊及社會大眾的高度肯定。然而，在現今醫療環境逐漸強調實證醫學的前提之下，安寧緩和醫療的發展已面臨到必須提出醫療證據的挑戰。目前在臺高安寧緩和醫療研究中所面臨的主要障礙因子，包括：（一）在安寧緩和醫療照顧上面對於研究重視的欠缺；（二）對於很多從事安寧緩和醫療研究的人員欠缺研究的訓練，或研究技能的訓練；（三）對於部份對安寧療護研究感到興趣的研究者，他們欠缺接觸安寧緩和醫療單位或與病人接觸的途徑；（四）對於安寧緩和醫療照顧研究上欠缺了一個對於倫理指引的共識；（五）在臺灣相當欠缺的在研究的合作，而研究的合作是包含了學術以和臨床的合作以及單位和單位的合作。因此，目前臺灣的安寧緩和研究則面臨了以下的挑戰：（一）平衡在安寧緩和醫療當中研究的價值以及實務的價值；（二）提供安寧緩和醫療人員正式的研究訓練；（三）提供研究者適當的管道能接觸及進安寧緩和醫療機構；（四）在必要的時候發展有關於安寧緩和醫療研究的倫理指標的共識（五）發展合作性的研究團體。為了突破這些常見的障礙以及面對這些挑戰，則需要『合作』以及『開放的胸襟』來面對安寧緩和醫療研究，相信未來嚴謹的安寧緩和醫療研究對於安寧療護未來的發展能夠提供更多實質上的幫助。

Hospice and palliative care movement has been widely promoted through a group of highly committed and enthusiastic professionals. The contributions of palliative care to improvement of the quality of terminal care and the dignity of dying patients have been well recognized by other disciplines and the society. However, under the stree of emphasis of evidence-based medicine, palliative care has faced several barriers and challenges in research in palliative care. These barriers include: (1) a lack of emphasis on value of research in palliative care, (2) a lack of well-trained research skills among palliative care professionals, (3) a very limited access to palliative care patients for researchers, (4) no consensus on ethical guidelines for palliative care research, and (5) a lack of cooperation in research efforts among different palliative care centers. In order to cope with these barriers, this has posed several challenges for palliative research, which include: (1) balancing the value of research and practice, (2) provision of formal research training programs for palliative care providers, (3) provision of access to palliative care units for researchers, (4) development of a consensus on ethical guidelines for palliative care research, and (5) development of collaborative research groups. Palliative care research is at a critical stage in its evolution in Taiwan.