重度居家醫療個案家屬對預立醫療決定的認知、態度及行為意向之探討

Exploring the Comprehension, Attitudes, and Behavioral Intentions of Family Members of Patients in Severe Home Health Care Cases Toward Advance Decisions

重度居家醫療病患的家屬，因著照顧病患或目睹病患從健康到完全失能的歷程，可能促使他們深度思考生命的本質與意義，進而關注病人自主權利法及預立醫療決定的可能性。本研究目的旨在探討重度居家醫療病患家屬對於「預立醫療決定」的認知、態度及行為意向，以及這三者之間的關係，並進一步分析家屬的人口學特性對認知、態度及行為意向的影響。以問卷調查法，立意取樣針對中部某醫學中心及地區醫院附設居家護理所之重度居家醫療病患的近親家屬進行研究。資料收集期間為2023年6月~10月，共取得199份有效問卷，運用SPSS 20.0進行統計分析，以描述性統計、Mann-Whitney U檢定、Kruskal-Wallis檢定及Spearman's rank correlation方法進行分析。研究結果：（1）八成以上的受試者理解預立醫療決定的生效條件，但對預立醫療決定的法定程序缺乏認知；（2）女性、非病患同住者、退休者與自覺身體狀況良好者，有較高的預立醫療決定認知；（3）50歲以下、教育程度高、與病患關係非常好者，有較正向的態度；（4）曾口頭表達疾病末期時的醫療，或已簽署不施行心肺復甦術同意書之病患的家屬，預立醫療決定的行為意向較高。

Family members of patients receiving Severe Home Health Care, through their caregiving experiences or witnessing the patient's progression from health to complete disability, may be prompted to deeply reflect on the nature and meaning of life. This reflection could lead them to pay closer attention to the Patients’Right to Autonomy Act and the potential for pre-signing Advance Directives. The aim of this study is to explore the family members' knowledge, attitudes, and behavioral intentions regarding Advance Directives for patients receiving Severe Home Health Care, as well as to examine the relationships between these factors. Additionally, the study analyzes how the demographic characteristics of family members influence their knowledge, attitudes, and behavioral intentions. Using a questionnaire survey, purposive sampling was conducted among close relatives of patients receiving Severe Home Health Care, affiliated with the home care departments of a medical center and a regional hospital in central Taiwan. Data collection took place from June to October 2023, resulting in 199 valid responses. Statistical analysis was performed using SPSS 20.0, with descriptive statistics, the Mann-Whitney U test, Kruskal-Wallis test, and Spearman's rank correlation method. Key findings: (1) Over 80% of respondents understood the conditions under which Advance Directives become effective but lacked knowledge of the legal procedures involved. (2) Women, non-cohabitating family members, retirees, and those who perceived themselves to be in good health had higher levels of knowledge about Advance Directives. (3) Respondents under the age of 50, with higher education levels, and those with very close relationships with the patient exhibited more positive attitudes. (4) Family members of patients who had verbally expressed their end-of-life medical preferences or signed Do Not Resuscitate (DNR) orders had higher behavioral intentions regarding Advance Directives.