急診推展安寧緩和醫療之困境與挑戰：系統性文獻回顧

Barriers to integrating hospice and palliative care into emergency units: a systematic review

人口迅速老化使重症及瀕死的病人之安寧緩和醫療需求上升，如何在急診環境中提供安寧緩和醫療以改善病人及家屬的生命末期照護品質成為一大挑戰。本研究旨在以系統性文獻回顧探討急診推展安寧緩和醫療之困境與挑戰。依循PRISMA指引進行文獻回顧，運用「急診」、「安寧緩和療護」、「困境」與「挑戰」等關鍵字，檢索PubMed、CINAHL、Embase、華藝線上圖書館等資料庫，納入條件：(1)中、英文原著質量性研究；(2)發表年份不限；(3)族群為急診就醫病人（年齡≥18歲）、家屬或醫療人員；(4)介入或主題與安寧緩和醫療相關。以QualSyst tool進行文獻品質評讀，採敘事統合法統整與分析結果，共收錄8篇研究，品質評讀總分介於90～95.5%。常見困境為(1)疾病嚴重度差異與家屬的不理解，使複雜的健康問題無法快速解決；(2)醫護人員對安寧緩和醫療的知識不足及溝通困難，導致識別病人需求及決策困難；(3)急救室空間不足且未設置安寧專區，致使提供照護受限；(4)缺乏決策資源系統整合，造成查詢與聯繫困難。建議增加具安寧緩和醫療專長的醫護人員，優化急診工作流程，改善硬體設施，並設立安寧緩和醫療獨立空間，使病人及家屬獲得支持與陪伴。強化健保系統整合，推動統一且即時的健康資訊系統，使醫療機構跨專業間能有效共享資訊，以提升急診病人安寧緩和醫療品質。

Rapid population aging has increased the demand for palliative care for critically ill and end-of-life patients. Improving quality of end-of-life care for patients and their families in emergency settings is a major challenge. This study aims to investigate barriers to integrating adult hospice and palliative care in emergency units. A systematic literature review was conducted following PRISMA guidelines. Relevant keywords, including“emergency department/unit,”“hospice/palliative care,”“obstacles/difficulties,”and“challenges,”were searched in the PubMed, CINAHL, Embase, and Airiti Library databases. Articles were included for analysis if they (1) were original qualitative or quantitative studies in Chinese or English, (2) included patients aged≥18 years, their families, and healthcare staff in emergency units, and (3) primarily focused on hospice and palliative care interventions. No restrictions on publication year were applied. The QualSyst tool was used for study quality assessment. Narrative synthesis was applied to consolidate and analyze the results. A total of eight studies with quality assessment scores ranging from 90% to 95.5% were included. The following obstacles were identified: (1) variations in disease severity and a lack of understanding from family members, hindering quick resolution of complex health concerns; (2) insufficient knowledge of hospice and palliative care, and poor communication skills among healthcare staff, complicating decision-making and identification of patient care needs; (3) limited space in emergency units and the absence of dedicated areas for hospice and palliative care, restricting the ability to provide appropriate care, and (4) lack of integrated decision-making resources, creating difficulties in information access and sharing. Emergency units should increase the number of health professionals specialized in palliative care, optimize emergency department workflows, improve infrastructure, and establish dedicated space for hospice and palliative care provision to provide support and companionship for patients and their families. Strengthening the integration of the healthcare system and promoting a unified, real-time health information system will enable effective interprofessional information sharing among medical institutions, thereby enhancing the quality of hospice and palliative care for emergency patients.