影響家庭照顧者預立醫療指示之因素

Influences of Caregivers to Sign Advance Directive

預立醫療指示（AD）已是公共衛生政策及國際關注的議題，在病人與家庭照顧者之間卻也是難以開啟的話題，鑑於家庭照顧者對預立醫療指示的不熟悉而凌駕病人自主權，甚至推翻病人的醫療決定，故，本文旨在了解臺灣家庭照顧者預立醫療指示之現況，並從居家照顧的角度，探討影響其預立醫療指示之意向因素。採橫斷式研究，簡單隨機抽樣，自擬結構式問卷，以家庭照顧者基本屬性、照顧型態及未來預立醫療指示意向量表進行資料收集。研究對象為花蓮縣南區接受居家照護之家庭照顧者，共取得211份有效問卷。運用SPSS 21.0進行統計分析，採用描述性統計、t檢定、單因子變異數分析及複迴歸分析。影響未來預立醫療指示意向重要因子，依其預測力為「性別」、「教育程度」、「年齡」與「經濟狀況」4個變項，共可解釋20.9%變異量。居家護理師同時兼具照護與教育責任，應主動以家庭為中心倡導預立醫療指示，讓更多家庭照顧者有機會參與討論。

Advance directive (AD) are global policies and concerns. However, due to the culture and custom in Taiwan, sometimes the caregivers may overthrow the autonomy and medical decision making of the patients because of the unfamiliar to AD. AD will be the difficult issues between caregivers and patients. To understand the current status of advance directive issues between caregivers in Taiwan, and to explore the factors that affect the decision making of AD. Cross-sectional and correlational designs were used. The questionnaire comprised the three subscales of basic attributes, care type and behavior intention of advance directive. There were 211 participants whom were recruited from four townships of Hualien County by simple random sampling. Data were analyzed by using descriptive statistics, t-test, one-way ANOVA, and multiple regression analysis by SPSS 21.0, Four variables showed significant predictor value in terms of positive impact on signing intentions of AD. These included ''Gender'', ''Education'', ''Age'', and ''Economic''. These items explained 20.9% of total variance. Home care nurses are responsible for nursing care to the patients and education to the caregivers. The mission of nurses is to guide patients and caregivers to understand the value and enhance the behavior intention of AD.