運用SWOT分析預立醫療照護諮商之推行──以某醫學中心之高齡病房為例

Using SWOT to analyze the promotion of advance care planning-an example of geriatric wards from a medical center

全球高齡化的問題日趨嚴重，突顯高齡末期照護之重要性。臺灣於2016年1月6日公布「病人自主權利法」，核心重點是：年滿20歲以上具有完全行為能力的人可以透過「預立醫療照護諮商」的過程，事先寫下書面的「預立醫療決定」，選擇接受或拒絕醫療。此法目的是要尊重病人醫療自主、保障善終權益，和促進醫病關係的和諧。然而，臨床上於住院老人推行預立醫療照護諮商之過程仍面臨許多困難。本文主要運用優勢、劣勢、機會、威脅(strengths， weaknesses， opportunities， threats; SWOT)分析方法，以某醫學中心之高齡病房為例探討推行預立醫療照護諮商之現況，並以關鍵結果領域(key result areas; KRAs)提出一項具體策略和成果指標。期望能幫助行政管理者釐清現存內在優勢與劣勢，和清楚外在機會與威脅，更期許本文能有助於未來醫院之相關政策的擬定和目標設定，進而提高預立醫療照護諮商推動的流暢度和被接受度。

The exponential growth of the aging population is a worldwide phenomenon which highlights the significance of the geriatric and end-of-life care of the elderly. The Patient Self- Determination Act (PSDA) was declared on January 6th, 2016 in Taiwan. The act declares that a person above the age of 20 with complete capacity has the ability to accept or refuse medical treatments during the process of advance care planning. The aim of this act is to respect patients' advance directives and to improve the relationships between health professionals and patients. However, it is still a challenge to introduce advance care planning to the elderly in clinical fields. This article illustrates the usage of the SWOT analysis to analyze the phenomenon of promoting advance care planning in the geriatric wards in a medical center and also provides two concrete strategies and result indicators to improve the situation through identifying the key result areas (KRAs). We expect that this article would be of help to administrators when identifying the strengths and weaknesses of internal environments within the hospital, and to understand the opportunities and threats of external environments outside of the hospital; therefore, this article could support administrators of hospitals to make related policies to enhance the accessibility and acceptability of advance care planning.