影響重症病人家屬簽署不施行心肺復甦術相關因素探討

The Factors Influencing the Behavior Intention of Do-Not-Resuscitate Requests for Families

目的：主要探討重症病人家屬簽署DNR的認知、態度及影響家屬簽署之相關因素。方法：以中部某醫院重症病人家屬共100位為研究對象。採結構式問卷，包括病人及家屬基本資料，家屬對簽署DNR的認知與態度。利用統計軟體SPSS 19.0版來進行統計分析。結果：研究結果發現：病人平均年齡為69歲，有71％診斷為末期癌症。只有28％的病人自己交代過不施行心肺復甦術。家屬方面簽署DNR者，以子女為多佔56％；而家屬與醫療人員討論過DNR者：以醫師佔85％、護理人員佔71％。家屬對簽署DNR的認知與態度都是正向的，總平均分別為3.79±1.55與3.53±2.32。在影響因素方面：病人年齡對家屬認知及態度是有顯著差異。病人年齡愈大，家屬對簽署DNR的認知及態度都愈正向。病人意識狀態對家屬簽署DNR的態度也有顯著差異。意識混亂甚至昏迷，家屬態度愈能接受簽署DNR。而病人自己交代過「不施行心肺復甦術」者，其家屬對簽署DNR的接受度亦較高。另外，聽過「安寧緩和醫療」相關資訊的家屬對DNR的認知亦具顯著差異。結論：由研究結果發現，家屬簽署DNR在認知與態度方面都是正向的，只是簽署的是家屬而非病人自己。建議醫護人員應鼓勵病人在意識清醒時預立醫囑、簽署「不施行心肺復甦術」意願書，如此可實質保障病人自己善終的權利。

Purposes: This study probes the factors that influence the behavior intention of Do-not-resuscitate (DNR) requests on families with critically ill patients. Methods: The subjects were critically ill patients in a hospital in central Taiwan (n=100). The research approach adopted a structured formula questionnaire, including the basic details of the patient and their family, family cognition and attitude toward signing a DNR request. It used the statistical software SPSS 19.0 version for statistical analysis. Results: The patient's mean age was 69, and 71% of patients had terminal cancer. Only 28% had signed the DNR request by themselves. Family members who mainly signed a DNR request for children accounted for 56%. Families who had discussed a DNR request with a doctor accounted for 85%, with nursing staff accounting for 71%. Familie’s cognition and attitude towards signed DNR were positive and the individual average scores were 3.79±1.55 and 3.53±2.32. With regards to influence factors, the cognition of families and the attitude of patient's age are the two aspects that show significance. The older the patient is, the more that families have cognition and their attitudes toward DNR requests were more positive. The patient's conscious state demonstrated significance when showing the attitude of families that sign a DNR request. The more confused and unconscious the patient is, the more a relative's attitude can be accepted and signed up for. If the patient explains “DNR” , then families can also accept signing a DNR request. In addition, listening to 'palliative care' with relative cognition of DNR demonstrates that relevant information plays a large part. The result of the study found that families who sign a DNR request with cognition and attitude were positive. This study can act as a reference for clinical practitioners by encouraging patients to take advanced directives and sign the form for “DNR” while they can make a clear and conscious decision, and this can, in essence, ensure the right to a natural death. Conclusions: Consideration of the principle of respect for autonomy and benefits for the patient. We should be encouraged to ensure that patients are clearly conscious when signing a 'DNR' request . This will also protect the reputation of the hospice. When necessary, families should follow the patient's wishes, as well seeking the best interests of the patient and making the decision if required.