凝視房間裡的大象：臺灣社區安寧緩和之整合性照護──以屏東縣某區域教學醫院為例

The Elephant in the Room: Integrative Care for Community Hospice Palliative Care in Taiwan: An Example of a Regional Teaching Hospital in Pingtung County

臺灣自2018年邁入高齡化社會，國人長期照顧需求、善終自主權益及安寧緩和是近年重視的議題。臺灣於全民健康保險制度下，政府積極推動在宅醫療，讓醫療資源可更彈性及有效被運用，減少醫療成本。因此，臺灣社區安寧緩和整合性照護網絡，勢必成為部分住院及機構式以外的主要照護模式。本文回顧臺灣安寧緩和療護發展及政策現況，藉由文獻查證，結合安寧療護所秉持的「五全照護」理念，介紹社區安寧緩和整合性照護，並以屏東縣社區化整合照護模式為例，提出國內目前居家安寧整合照護執行現況以及未來政策修正之建議。期望提供衛生主管機關與醫療院所未來推動社區安寧緩和政策之參考。透過整合性照護模式，擴大以社區為基礎的安寧療護服務量能，提供末期病人、家屬及照顧者獲得安寧緩和療護持續性支持，在社區照護階段享有生理舒適及心理安適的照護品質，實現華人傳統社會文化中在宅善終的心願。

Taiwan has been an aging society since 2018. As a result, long-term care, end-of-life autonomy, and hospice care have received increasing attention. The government of Taiwan promotes home-based healthcare through the National Health Insurance System to enable the efficient utilization of medical resources and reduce overall medical costs. Taiwan’s community hospice and palliative care network is expected to serve as the main care model supplementing partial hospitalization and institutional care. In this article, we review the history of and policies related to hospice and palliative care in Taiwan using a literature review and examining Pingtung County as a case study. The implementation of home-based palliative care is also outlined and policy revisions are proposed. The results are intended to provide a reference for healthcare authorities and medical institutions to promote community hospice and palliative care policies. The integrated care model can enhance the capacity of community-based palliative care, support patients receiving palliative care and their family members and caregivers, and ensure physical and psychological comfort for patients. This model contributes to the realization of older adults’preference for dying at home, which is especially pronounced in cultures where traditional Chinese ideas are deeply rooted.