腎臟科醫護人員預立醫療指示認知及推動意願之探討

An Investigation on the Cognition of Advance Directive and Willingness to Promote Advance Directive in Nephrology Staff

血液透析治療延長末期腎臟病人的生命，但因疾病的合併症也帶來負向的生活品質，臨床上努力推廣預立醫療指示，期望讓病人能自主決定並且透過預立醫療指示的方式來選擇符合個人期待之醫療計畫，讓病人能善生與善終。第一線的醫護團隊如何及早適切的介入是很重要的，因此針對腎臟科醫護人員對預立醫療指示之了解程度及推動意願進行調查分析，以做為未來專科推動預立醫療自主計畫時的參考依據。

方法：橫斷相關性研究，採立意取樣法，以北部某醫學中心腎臟科醫護人員為對象，利用自訂之結構式問卷，了解腎臟科醫護人員對預立醫療指示之瞭解程度及推動預立醫療指示意願。

結果：本研究共收案共65 人，腎臟科醫護人員簽署預立醫療指示者僅5%，在對於「預立醫療指示相關條例的認知」中有三項得分偏低，分別是能區別預立醫療指示與不施予心肺復甦術的差別（M = 2.94±0.83）、能暸解預立醫療指示介入時應注意的事項（M = 2.97±0.92）及對修法後安寧緩和條例的適用範圍（M = 3.00±0.85）。年齡與預立醫療指示的認知呈現正相關（r = .262；p < 0.05）；對生命的認知得分越高及對預立醫療指相關條例的認知越清楚，越有意願推動預立醫療指示。

結論：應強化醫療人員對預立醫療指示概念認知的重要性，才能在最佳的時機介入提供病人及家屬所需的協助，發揮最大的效益。

 

Hemodialysis prolongs the lives of patients with end-stage renal disease, but also leads to negative quality of end life due to disease comorbidities. Clinically, we strive to promote advance directive (AD) and wish patients can select a medical plan of their own choosing and meeting their expectations for a good end life. It is very important to start AD process early and at a proper time, therefore, the purpose of this study is to investigate the degree of AD cognition and willingness to promote AD, which can serve as references to promote AD in the future.

Methods:After purposive sampling for cross-sectional correlation study, nephrology staff from a medical center in the north of Taiwan were enrolled in a structured questionnaire to understand the “Cognition of Hospice Palliative Care Regulation and AD”and “Willing to Promote AD”.

Results:Among the 65 cases collected in this study, only 5% of the nephrology staff signed the AD. Scores on three items: “distinguish the difference between AD and do not resuscitate (DNR) (M = 2.94±0.83)”, “understand what should be noted when applying AD interventions (M = 2.97±0.92)”, and “awareness the scope of application about Hospice Palliative Care Regulation (M = 3.0±0.85)”were lower. Analyses showed a positive correlation between age and “Cognition of Hospice Palliative Care Regulation and AD”(r = 0.262; p < 0.05). We also found the higher the score for the cognitive of life, and “Cognition of Hospice Palliative Care Regulation and AD”, the more “willing to promote AD”.

Conclusion:To strengthen and educate medical staff to understand the importance of Hospice Palliative Care Regulation and AD. Apply AD process at a proper time to achieve maximum benefits for more patients and their families.