初探臺灣原住民族文化適切性社區安寧療護模式之需求與省思

Preliminary Exploration for Development of a Culturally Appropriate Community-Based Hospice and Palliative Care Model for Taiwanese Aboriginals

研究目的：高齡化社會所帶來長期照顧的需求及挑戰為目前國內重要且急迫待解決之議題。擴大以社區為基礎的安寧療護服務量能以滿足龐大照護需求為現行國內長期照顧十年計劃2.0的發展重點之一。臺灣本土安寧療護照護模式皆以主流漢人文化與都市設置為設計參考，針對原住民族不同文化脈絡與居住環境下的生死觀、健康認知與安寧療護之研究甚少。本研究分析目前臺灣原住民族社區安寧療護發展之困境，並提出改革建議。研究方法：採描述性論述，以關鍵字「原住民族」、「社區長期照顧」與「安寧療護」，針對華藝線上圖書館、PubMed與Google搜尋引擎進行文獻回顧，共收錄16篇文章，描述問題並提出可能之興革建議。研究結果：國內發展具原住民族文化適切性之社區安寧療護模式缺乏完善法令支持，且未有足夠之研究引導臨床服務。研究團隊提出三點跨文化照顧重點：（1）全面性、整體性與系統性之文化調查、探勘與資料庫建置；（2）政策應考量原住民族面臨之健康不均等現況以個別化修訂相關法規；（3）培養臨床與研究人才以發展跨文化的安寧療護模式。研究結論：期待國家能正視部落自主與文化獨特性，依照不同文化背景與個別考量，投入資源與擬訂配套措施以培訓部落族人於在地提供安寧療護，進而達到族人在地老化以及在部落善終的目標。

Purpose: There is an urgent need to address the challenges surrounding long-term elder care in Taiwan. One of the key developmental strategies employed in the National Long-term Care Plan 2.0 is the expansion of community-based hospice and palliative care services. Most palliative care models are based on Taiwan’s mainstream Han culture in urban areas. Little research has been conducted on the conceptualization of life and death, health cognition, or palliative care in the context of Taiwanese aboriginal cultures. In this article, we identify the challenges to develop a culturally appropriate community-based palliative care model for Taiwanese aboriginals and propose reforms. Methods: We conducted a narrative literature review on Airiti Library, PubMed, Google searching engine using ‘indigenous people’, ‘community-based long-term care’ and ‘palliative care’ as keywords. We included 11 academic articles and 5 policy papers to explore potential obstacles and propose suggestions for development of a palliative care model appropriate for Taiwanese aboriginal communities. Results: We found little policy support and inadequate research to guide delivery of culturally-appropriate care. We recommend: (1) a comprehensive and systematic culture investigation and database development; (2) the health inequality of indigenous people should be taken into account when creating policy based on individual needs; (3) and the cultivation of clinical and research talent to develop a cross-cultural palliative care model. Conclusions: We urge the government to secure funding to develop programs to support hospice and palliative care development by local stakeholders according to their individual needs and unique cultural backgrounds in order to allow aboriginal elderly people to age in place with a good death in the community.