生命自主方案，對輕度認知障礙者與其家庭照顧者參與，預立醫療照護諮商及末期維生醫療抉擇意向之影響

Effect of life autonomy programs on engaging in advance care planning and end-of-life care decisions for people with mild cognitive impairment and their family caregiver

目標：探討生命自主方案對輕度認知障礙者或失智者與其家庭照顧者參與正式預立醫療照護諮商（ACP）及末期維生醫療抉擇意向之影響。方法：採單組前後測之前實驗法，招募55歲以上、診斷為輕度認知障礙或輕度失智症、未參與過正式ACP，且其家庭照顧者亦同意參加者納入本研究。由受過ACP訓練且有失智症照顧經驗的護理師進行介入。以結構性問卷進行資料收集，並以成對樣本t檢定及組內相關係數比較介入前後差異與一致性。結果：共44對參與者完成本研究，介入後參與者在失智末期治療及ACP認知均顯著提升（p < .01），認知障礙者簽署「預立安寧緩和醫療暨維生醫療抉擇意願書」（p < .05）及「醫療委任代理人委任書」（p <.05）可能性顯著增加，家庭照顧者為認知障礙親人簽署「不施行心肺復甦急救同意書」可能性顯著提升（p < .05），二者對於末期照護維生醫療抉擇一致性亦增加。結論：生命自主方案對輕度認知障礙者或失智者與其家庭照顧者末期維生醫療抉擇意向與一致性有顯著正向影響。建議照護團隊正視此群體接受ACP的平等性與可近性，儘早進行ACP溝通與討論，改善其末期照護品質。（台灣衛誌2021；40(6)：699-712）

"Objectives: Exploring the effect of a life autonomy program on the engagement in advance care planning (ACP) and end-of-life (EoL) care decisions among people with mild cognitive impairment (PWCIs) or mild dementia and among their family caregivers (FCGs). Methods: A one-group, pretest–posttest design was applied. The inclusion criteria for PWCIs were: aged >55 years, had a diagnosis of mild dementia or mild cognitive impairment, and had never participated in a formal ACP consultation. Their FCGs also must have agreed to participate in the study. The intervention was provided by an ACP-trained registered nurse. A structured questionnaire was used for data collection, and paired t tests and the intraclass correlation coefficient were used to compare the differences between pre-intervention and post-intervention. Results: A total of 44 dyads of participants completed this study. After the intervention, both PWCIs and their FCGs had significantly greater knowledge of end-stage dementia treatment and ACP (p <.01). PWCIs were significantly more likely to sign advance directives for palliative care (p < .05) and for a health care agent (p < .05). FCGs were also significantly more likely to sign do not resuscitate consent forms for PWCIs (p < .05). The consistency of EoL care decisions also increased between PWCIs and FCGs after intervention. Conclusions: Life autonomy programs significantly and positively affect the PWCIs’and FCGs’consideration of EoL care decisions. We suggest for care teams to recognize the equality of and accessibility to ACP for this PWCIs, promote the communication and discussion of ACP as soon as possible, and improve the quality of EoL care for PWCIs. (Taiwan J Public Health. 2021;40(6):699-712)"