高雄市醫療機構預立醫療諮商照護團隊運作現況與社會工作實踐經驗之初探

Preliminary Exploration of the Operation and Practical Experiences of Social Work of Advance Care Planning Teams in Kaohsiung Medical Institutions

在「病人自主權利法」的立法精神與法律規範下，國內各醫療機構從試辦到正式實施，開始落實預立醫療照護諮商（以下簡稱ACP）團隊運作，此運作經驗對落實立法精神和發展有效諮商團隊十分重要，加上國內目前尚缺乏相關研究，故本研究以高雄市醫療機構為場域，採用焦點團體訪談法與深度訪談法進行資料蒐集，共計訪談7位醫務社工師，以探討不同層級醫療機構的諮商團隊運作現況、專業間合作及社工師實務經驗。其主要目的，在於累積國內預立醫療照護諮商團隊運作經驗，提升專業間合作效能。
研究初步發現：1、諮商機構在政策配合與資源投入最少的管理策略下，ACP團隊的運作，以家庭醫學部安寧醫療照護成員為班底，諮商空間為門診診間，並呈現多元最大與必要最低限度的兩種發展方式。2、ACP團隊專業間的任務分工和合作，具有明顯的任務取向與重視時程的特性。3、社工師在Pre-ACP的業務內容具有專業表現的機會，但因屬多工型職務，負擔較大。4、社工師因上述團隊運作特性，社心議題較不易在ACP諮商過程被觸及，相對的其專業知能，也較難派上用場。
根據以上的初步發現，本研究分別未來政策分向、諮商機構、團隊專業間合作、社工師專業定位等層面，提出具體的建議供參考。

Under the legislative spirit and the legal framework of the Patient Right to Autonomy Act, Taiwan’s medical institutions start to implement the team operations of advance care planning (hereinafter referred to as ACP) after going through the process of trial operation to formal implementation. The operational experience is crucial to solidifying the legislative spirit and development of effective counseling teams, while relevant studies are lacking domestically. Therefore, this study takes the medical institutions in Kaohsiung City as the research field, and collected data with focus group interviews. A total of seven medical social workers were interviewed to discuss the current operation of the counseling teams, interdisciplinary collaboration, and practical experience of social workers in medical institutions at different levels. The main purpose is to systematically accumulate experience in the operation of teams and improve the efficiency of interdisciplinary collaboration.
Preliminary findings of the study suggest that: 1. as the counseling institutions are managed under the strategy of policy coherence and minimal resource investment, the operation of ACP teams mainly relies on the hospice care staff of the family medicine departments. The outpatient clinics are used as the venues for counseling, while there are two methods of development, namely, multivariate maximum and necessary minimum. 2. The division of tasks and cooperation among disciplines of advance care planning teams have significant characteristics of being task-oriented and giving importance to schedule. 3. The social workers have a chance to practice their professions while performing the tasks of Pre-ACP, but, they also have heavy burdens to bear as they have to perform multiple tasks. 4. Due to the above mentioned characteristics of team operation, social workers face obstacles in bringing up the topics of social psychology during the counseling process, while it is also not easy for them to apply relevant professional knowledge.
Based on the above preliminary findings, this study proposes concrete suggestions for reference in the aspects of future policy direction, counseling institutions, interdisciplinary collaboration of the teams, and the professional positioning of social workers.