社區民眾對於預立醫療決定行為意向及其相關因素之探討

Advance Decision Behavioral Intention and Related Factors in Adults Living in the Community

背景：醫療科技進步，不健康存活年數逐年增加。為使病人臨終時家屬面臨末期醫療決策時有所依循，降低無效醫療，提高生活品質與善終，瞭解民眾對於預立醫療決定行為意向及其相關因素，才能有效提高其決策能力。
目的：探討社區民眾對於預立醫療決定行為意向與其相關因素。
方法：本研究採橫斷性研究設計，針對社區民眾，以紙本與網路問卷方式進行基本屬性、預立醫療決定的經驗、預立醫療決定知識、態度、行為意向、靈性健康、社會支持之資料收集。統計方式以描述性統計與獨立樣本t檢定、單因子變異數分析、皮爾森積差相關分析、多元迴歸分析等推論性統計。
結果：共377位社區民眾參與本研究（平均年齡為50.57歲，SD = 13.39，58.4%女性），其預立醫療決定行為意向高，假如未來處於永久性植物人狀態時，會拒絕氣管內管插管（4.13分，SD = 0.92）、葉克膜（4.09分，SD = 0.95）、體外心臟按摩（4.08分，SD = 0.95）、心臟電擊（4.08分，SD = 0.98）急救措施為較高分項目。預立醫療決定行為意向重要預測因子為性別、有書面表達生命末期醫療決策、會參加病人自主權利法及預立醫療決定的宣導講座、預立醫療決定態度、與社會支持（R2 = 40.1%, p < .001）。
結論／實務應用本研究發現社區民眾的預立醫療決定行為意向及重要影響行為因素，為未來提升民眾預立醫療決定簽署率等相關政策措施重要參考。

Background: Improvements in medical science and technology have increased the average number of years that older adults survive with impaired quality of life. Understanding behavioral intentions and related factors affecting advance decision (AD) decision-making can help medical professionals improve the decision-making ability of patients, allowing patients and their family members to make better medical decisions that reduce ineffective medical treatments, improve quality of life, and facilitate a good death.
Purpose: This study was developed to explore behavioral intentions and related factors during the process of AD decision-making among community adults.
Methods: A cross-sectional study design was used in this study. The knowledge, attitudes, and behavioral intentions regarding AD decisions, spiritual health, and social support were measured in a convenience sample using physical or internet-based questionnaires. Data were analyzed in SPSS 21.0 using descriptive and independent samples t-tests, one-way ANOVA, Pearson correlation, and multiple regression analysis.
Results: Three hundred and seventy-seven community adults participated in this research (50.57 years old, SD = 13.39; 58.4% female). The average level of AD-related behavioral intention was found to be high, with high numbers of participants indicating that they would refuse endotracheal intubation (4.13, SD = 0.92), extracorporeal membrane oxygenation (4.09, SD = 0.95), extracorporeal heart massage (4.08, SD = 0.95), and defibrillation (4.08, SD = 0.98) if they were in a permanent vegetative state in the future. The important predictors of AD behavioral intention included gender, written expression of end-of-life medical decision-making, participation in the patient self-rights law and advance decision publicity lectures, having an advance decision attitude, and social support (R2 = 40.1%, p < .001).
Conclusion/ Implications for Practice: A high level of AD-related behavioral intention was found in the sample and several important factors that influence related behaviors were identified. These results provide an important reference for related public policymakers to increase the percentage of older patients participating in advance directive decision-making.