提升南部某教學醫院癌症末期病人不施行心肺復甦術簽署率之改善方案

Project to Enhance the Do-Not-Resuscitate Order Signing Rate among Terminal Cancer Patients at a Teaching Hospital in Southern Taiwan

癌症為國人十大死因之首位，簽署不施行心肺復甦術（DNR）可免除癌症末期病人於急救過程及後續維生醫療所造成的痛苦。本專案旨在提升癌症末期病人不施行心肺復甦簽署率。經參考相關文獻資料制定「護理人員對癌症末期病人簽署不施行心肺復甦術認知調查表」、「癌症末期病人簽署不施行心肺復甦術認知調查表」，另深入訪談認知不足原因以癌症末期病人簽署不施行心肺復甦術訪談調查表，發現造成現況因素為：醫護人員對DNR專業知識不足、病人對DNR認知不清楚、缺乏DNR說明輔助工具、參閱手冊與宣導工具。改善措施包括：舉辦DNR相關課程、推動醫病共享決策輔助工具參閱本、製作布袋戲「戲說人生～DNR及安寧療護」影音光碟、推廣DNR及安寧療護海報與DNR QR Code影音連結等措施。專案實施後成效評值顯示癌症末期病人不施行心肺復甦術簽署率由36.6%提升至64.3%，達專案改善成效。

Cancer has consistently been the leading cause of death in Taiwan for decades. Signing a do-not-resuscitate (DNR) order can help reduce suffering among terminal cancer patients during emergencies and subsequent life-sustaining treatments. This project aimed to enhance the DNR order signing rate among terminal cancer patients. Assessment tools such as the＂Nurses' perceptions of DNR order signing among terminal cancer patients＂questionnaire,＂Terminal cancer patients' perceptions of DNR order signing＂questionnaire and In-depth interviews to understand the reasons for lack of professional knowledge＂Interviews with terminal cancer patients on DNR order signing＂questionnaire, were formulated based on relevant studies and data. The results revealed several existing conditions pertaining to the signing of DNR orders, including the lack of professional knowledge on DNR among nurses; the lack of awareness regarding DNR among patients; and the lack of DNR-related aids, handbooks, and educational tools. Various measures for improvement were implemented, such as organizing DNR-related courses; promoting aids and reading materials covering shared decision making; producing a glove puppetry video CD titled＂A Story about Life ~ DNR and Hospice Care＂; putting up posters promoting DNR and hospice care; and introducing QR codes linked to DNR-related videos. The result showed that the DNR order signing rate among terminal cancer patients increased from 36.6% to 64.3% following the project's implementation. The project was effective in improving the DNR order signing rate.