執行預立醫療決定時照護地點與死亡地點之初探

Abstract

過去許多研究顯示自宅為末期病人最期待之照護與臨終地點，然而對於處於非生命末期階段者執行預立醫療決定（Advance Decision, AD）時的照護與臨終地點之期待仍尚未釐清。因此，本研究分析參與預立醫療照護諮商（Advance Care Planning, ACP）之意願人對於照護與死亡地點之選擇以及影響之因素。本研究採次級資料分析法，使用2019年1月至12月臺北市某區域教學醫院各院區2,324位意願人之預立醫療決定內容進行分析。結果顯示大多數意願人尚未能決定自身期待之執行AD時的照護與死亡地點（49.9%與52.8%），若意願人有表達地點之選擇，最多期待之照護與死亡地點為醫院（35.2%與35.1%），其次為家中（12.7%與11.6%），再者為長照機構（9.0%與5.6%），其中年長者、曾經或目前罹癌者及同意器官或遺體捐贈者，更傾向選擇在醫院執行AD時的照護與善終地點（罹癌者：47.2%與48.0%；任何器官：44.9%與44.9%；部分器官：40.9%與45.5%；遺體捐贈：45.6%與44.0%）。本研究結果未發現「在宅善終」是主要的期待死亡地點，而執行AD時的照護與死亡地點的選擇與意願人的年齡、是否罹癌、器捐或遺體捐贈意願有關，亦可能與城鄉特性、文化特色、以及醫療制度的模式與完備性有關。

Previous studies have shown that home is the most preferred place of care and place of death for end-of-life patients. However, the preferences for place of care and place of death for people who are not in end-of-life implementing advanced decision (AD) has not yet been clarified. Therefore, this study aimed to explore the preferences and the factors for place of care and place of death when people who participated in Advance Care Planning (ACP). This study adopted secondary data analysis to examine the Advance Decision by 2,324 people in each branch of a regional hospital in Taipei City from January to December 2019. The results showed that most people have not yet determined their preferences for place of care and place of death when implementing AD (49.9% and 52.8%). If a person chose the place, the most preferred place of care and place of death was hospital (35.2% and 35.1%), followed by homes (12.7% and 11.6%), and long-term care facilities (9.0% and 5.6%). Among them, the elderly, those who were diagnosed as cancer, and those who had decided to donate organ or body, were more inclined to choose the place of care or place of death in hospital when implementing AD (person with cancer: 4.2% and 48.0%; any organs donor: 44.9% and 44.9%; some organs donor: 40.9% and 45.5%; body donor: 45.6% and 44.0%). This study did not show `people prefer to die at home` which have usually been evidenced in previous research, and the preferences for place of care and place of death when implementing AD was related to factors, such as age, cancer diagnosis organ or body donation, and might also be related to urban and rural characteristics, cultural characteristics, the model and completeness of the medical system.