探討台灣南部某區域醫院預立醫療照護諮商門診參加者完成預立醫療決定的相關因素

Factors Associated with Completion of Advance Directives among Advanced Care Planning Outpatients at a Regional Hospital in Southern Taiwan

目的：在台灣，民眾可以透過「預立醫療照護諮商」門診簽署「預立醫療決定」，然而諮商門診目前仍未被廣泛使用。本研究目的是希望了解影響民眾來本院參與預立醫療照護諮商門診和簽署完成預立醫療決定的相關因素。

方法：我們使用回朔性病歷研究，研究對象為針對2019年1月1日到2020年2月28日來本院諮商門診的參與者。校正相關共變項後，使用羅吉斯回歸評估完成預立醫療決定的相關影響因素。

結果：總共144位參加者被納入研究，預立醫療決定完成率為90.2%。較多的參加者為年齡較大、女性、較為健康、費用較低和之前已簽過預立安寧緩和醫療暨維生醫療抉擇意願書。校正相關共變項後，之前已簽過預立安寧緩和醫療暨維生醫療抉擇意願書的參加者有較高的機會完成預立醫療決定(aOR 14.56, 95% CI 1.62-131.23)；參加者與有社工參與的諮商團隊進行諮商有較高的機會完成預立醫療決定(aOR 5.59, 95% CI 1.05-28.87)。

結論：諮商門診的參加者其預立醫療決定完成率高，之前已簽過預立安寧緩和醫療暨維生醫療抉擇意願書的參加者有較高機會完成預立醫療決定。諮商時，針對參加者個別情況進行討論和使用輔助資料理解諮商內容，協助完成預立醫療決定。未來能針對社區民眾衛教宣導預立醫療照護諮商門診的諮詢服務，針對從未簽過預立安寧緩和醫療暨維生醫療抉擇意願書的民眾更需進一步的推廣。

 

Purpose: Advance care planning (ACP) is the process of communicating a person’s preferences regarding future medical care. In Taiwan, people can visit an ACP outpatient clinic and complete advance directives (AD). ACP is an emerging medical service, and information about completing AD is lacking. The aim of this study was to investigate the factors affecting AD completion among ACP clinic outpatients at a regional hospital in southern Taiwan.

Methods: This retrospective study used chart reviews to evaluate participants who attended an ACP outpatient clinic from 1 January 2019 to 28 February 2020. AD completion was analyzed using logistic regression after adjusting for covariates including previously signing do-not-resuscitate (DNR) forms.

Results: A total of 144 participants were included, and the AD completion rate was 90.2%. Participants attending ACP sessions were more likely to be older, female, having a high school education and below, better health status, paying less for ACP sessions, and previously signing DNR forms. After adjusting for the covariates, participants who had previously signed DNR forms were more likely to complete AD (aOR 14.03, 95% CI 1.56-126.06). In addition, the presence of a social worker in the ACP team was significantly associated with higher AD completion (aOR 5.74, 95% CI 1.05-31.32).

Conclusions: Participants previously signing DNR forms were more likely to completion AD. In addition to tailoring ACP discussions about the benefits of AD and providing supplement materials to improve AD completion, further strategies are needed to encourage the public in southern Taiwan to visit ACP outpatient clinics, especially for those who were unfamiliar with concepts such as DNR or life-sustaining treatment at the end of life.