居家醫療個案接受安寧療護之相關因素

Factors Associated with Eligibility for Palliative Care among Home Care Patients

目的：臺北市某醫院自2016年起，在所屬院區推動居家安寧醫療。本文分析某院區所服務之居家病人之中，影響病人接受安寧醫療之相關因素。方法：本研究為橫斷面研究。從2016年3月至2018年11月初，居家病人366位，有接受安寧醫療145人（39.6％），沒有接受安寧醫療221人（60.4％）。研究變項分類：病人的人口學特性、疾病史、功能狀態、照護、社會支持等。以逐步多變項邏輯斯迴歸分析影響病人接受安寧醫療之相關因素。結果：有家庭會議的病人接受安寧醫療的機會較高（OR 16.49, 95％ CI 7.75－35.10）；安寧緩和照護需求評估4分（含）以上，接受安寧醫療的機會較高（OR 27.54, 95％ CI 7.93－95.68）；有鼻胃管的病人，接受安寧醫療的機會較低（OR 0.33, 95％ CI 0.18－0.58），照護日數每增加一日，減少0.3％接受安寧醫療的機會（OR 0.997, 95％ CI 0.996－0.998）。結論：家庭溝通會議及安寧緩和照護需求評估，可以提高病人接受安寧醫療的機會。有鼻胃管的病人和照顧日數較長的病人，接受安寧醫療的機會較低。建議醫師根據安寧緩和需求評分的結果，在分數達到4分（含）以上時，召開安寧緩和家庭溝通會議，討論病人進入生命末期的照護計畫，並且協助家屬之間不同意見的整合。

Purpose: As Taipei City Hospital has provided palliative home care at all branches since 2016, the study was conducted to examine the factors associated with the eligibility for palliative care among patients receiving home medical care. Methods: This is a cross-sectional study. From March 2016 to November 2018, 366 home care patients were recruited. 145 (39.6%) of the patients received palliative home care, and 221 (60.4%) did not. Variables included demographic characterisitcs, history of disease, functional status, care, social support. Stepwise multivariable logistic regression was used to evaluate the factors associated with palliative home care. Results: According to the results of stepwise multiple-logistic regression, factors associated with increased eligibility for palliative care included family meeting (OR 16.49, 95% CI 7.75- 35.10) and a hospice eligibility score of 4 points or higher. (OR 27.54, 95% CI 7.93-95.68). The eligibility for palliative home care diminished with the use of nasogastric feeding tube (OR 0.33, 95% CI 0.18-0.58) and the increase in the length of home care (OR 0.997, 95% CI 0.996- 0.999). Conclusion: Agreement reached through family meeting and a high hospice eligibility score appear to increase the likelihood of a home care patient's receiving palliative home care, whereas the use of nasogastric tube and increased length of home care reduce the likelihood. When the hospice eligibility score of a patient reaches 4 points or beyond, a family meeting to integrate different opinions about end-of-life care is recommended.