提升非安寧病房之癌症末期病人不施行心肺復甦術簽署率

Improvement of Terminal Cancer Patient’s Do-Not-Resuscitate Signing Rate in the Non-Hospice Ward

醫療科技發展的目的是為了拯救病人生命及減輕痛苦，而非拖延病人的死亡及增加其痛苦。現況非安寧病房之癌症末期病人安寧療護涵蓋率72.5%、DNR簽署率72.7%，分析原因為：「癌症末期病人問題評估表」之內容未涵蓋血液科症狀，醫師對於疾病程度認定不一致、擔心醫糾，致提出會診安寧照護團隊比率僅43.5%、醫師因疾病特性病情進展快速，告知病情抉擇時機太晚，導致未告知病人末期抉擇、病人及家屬不清楚急救過程及病人急救後之痛苦情境，造成徒增病人的痛苦與家屬的遺憾，亦增加併發症傷害等醫療糾紛。經制定「醫病共享決策輔助工具」、「急救設備圖示卡」及「生命的抉擇」衛教檔案，舉辦「醫病五溝通」及「病人自主權利法暨安寧與器捐」衛生講座，使癌症末期病人簽署「不施行心肺復甦術」比率由改善前72.7%提升至89.7%，會診安寧共同照護團隊之比率由改善前43.5%提升至88.2%，且其癌症末期病人之家屬對醫師病情解釋滿意度由改善前73.1%提升至90.4%。改善成效卓越，讓癌末病人減少臨終時的痛苦，提升癌末病人和家屬生活品質的全人照顧。

The primary objective of advancing medical technology is to preserve patients' lives and alleviate their suffering rather than prolonging their existence and increasing distress. Currently, non-hospice wards exhibit a 72.5% coverage rate for end-stage cancer patients receiving hospice palliative care, with a 72.7% signing rate for Do Not Resuscitate (DNR) directives. A critical analysis revealed that the ''End-stage Cancer Patients Problem Assessment Form'' lacks coverage of hematological symptoms, contributing to a consultation and care team ratio of only 43.5%. The rapid progression of diseases, coupled with delayed communication of decisions to patients, results in a lack of awareness about the first aid process and the subsequent painful situations among patients and their families. The root cause analysis identified that the omission of hematological symptoms in the ''Patients with Terminal Cancer Appraisal Forms'' led to inconsistent disease assessments by physicians, causing concerns and hindering effective hospice consultations. To address these challenges, initiatives were implemented, including the development of ''Shared Decision-Making Tools,'' ''First-Aid Equipment Icon Cards,'' and ''Life Choices'' health education materials. Additionally, programs such as ''Healing Five Communication'' and ''Patient Autonomy Rights Law cum Tranquility and Donation'' health lectures were organized. These interventions significantly improved the rates of end-stage cancer patients signing DNR directives, increasing from 72.7% to 89.7%. The consultation rate for hospice team care also rose from 43.5% to 88.2%. Patient satisfaction with the explanation process increased from 73.1% to 90.4%. These improvements demonstrate the effectiveness of the initiatives, reducing end-stage cancer patients' pain during the dying process, improving their quality of life, and fostering holistic care for their families.