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E90070
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癌末病患人工營養適切性及臨床指引建立之研究
The Terminal Cancer Patients\' Willingness and Its Correlating Factors toward the Artificial Provision of Nutrition and Hydration in Taiwan
1.邱泰源
1.Tai-yuan Chiu
1.國立臺灣大學醫學院家庭醫學科
1.College of Medicine, National Taiwan University
001,002,003,004
1.國立臺灣大學醫學院家庭醫學科
1.College of Medicine, National Taiwan University
002
1.行政院國家科學委員會
1.National Science Council
A.14 計畫執行期間(起):2001-08-01
A.14 計畫執行期間(訖):2002-07-31
2001-08-012002-07-31
A.16 收到日期:2002-11-05
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住進國立台灣大學附設醫院緩和醫療病房之病人

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218


218
001,004
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C.2 聯絡日期:2002-11-08
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1.國立臺灣大學醫學院家庭醫學科
1.College of Medicine, National Taiwan University
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C.7 資料公開日期:2003-08-01
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008
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001
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1.人工營養水分
2.知識
3.意願
4.態度
5.癌末
1.Artificial Nutrition and Hydration
2.Attitude
3.Knowledge
4.Terminal Cancer
5.Willingness
癌 末病人使用人工營養水分為臨床上常見的倫理困境。了解癌末病人使用人工營養水分的意願並尊重其價值觀是緩和醫療臨床決策的基礎。本研究之目的為了解癌末病 人使用人工營養水分的意願,並探討其相關因素。 研究對象為一年間所有住入台大醫院緩和醫療病房意識清楚同意訪談的病人,共完成81位問卷訪談。81位病人中,55位(67.9%)在近一個月內曾使用人 工營養水分。知識測量可發現正確率偏低,由高而低排序如:周邊靜脈只能提供水分補充(44.4%),人工營養水分可代表家屬的關心及照顧(34.6%), 過多人工營養水分可能促進癌細胞增生(26.0%),人工營養水分可延長生命(17.3%),人工營養水分可免於餓死(3.7%)。對人工營養好處的態度 最多為:可提供營養及水分,而對人工營養水分的負擔之態度最多為:會使血管變硬。38位(46.9%)病人仍表示有意願使用人工營養水分,而 Logistic迴歸分析則顯示:使用人工營養水分的經驗,人定勝天型的個性是有意義的預測因子(OR=5.48, 95% CI: 1.77-16.09; OR=0.46, 95% CI: 0.27-0.77)。 結論:本研究結果呈現出台灣癌末病人仍相信人工營養水分的效用,應針對本研究分析出的相關因素更進一步研究,並使用於教育宣導及臨床溝通上,如此將有助於 癌末照顧品質提升。

Background and purposes: The ethical dilemmas related to hydration and nutrition in patients with terminal cancer are easily arose in the process of palliative care. To identify the willingness of terminal cancer patients and respect for their values are important in the clinical decisions for the provision of artificial nutrition and hydration (ANH). The aim of this study was to identify the patient\'s willingness and determine its correlating factors toward the provision of artificial nutrition and hydration in terminal cancer. Methods: Eighty-one patients with terminal cancer, admitted to a palliative care unit in Taiwan in the one-year period, had completed a questionnaire interview. Results: Fifty-five patients (67.9%) out of 81 have used ANH in recent one month. Knowledge test on the issues of ANH showed the rates of accurate answers were ranked as peripheral IV route can only provide hydration (44.4%), ANH can represent the care of families (34.6%), excessive artificial nutrition may increase the proliferation of cancer cells (26.0%), ANH can prolong life (17.3%) and can avoid of the hunger to die (3.7%). The strongest attitude of patients toward the benefit of ANH was \"it can provide the need of nutrition and hydration\". Otherwise, the strongest attitude toward the threats of ANH was \"ANH will make their blood vessels harder\". Thirty-eight patients (46.9%) out of 81 still expressed their willingness to have ANH. Theresults of logistic regression analysis showed that the experiences of using ANH and the belief of \"overcoming everything\" were the most significantvariables related to the willingness of patients to use ANH (OR=5.48, 95% CI=1.77-16.90; OR=0.46, 95% CI=0.27-0.77). Conclusions: Taiwanese patients still believed the effects of ANH, even in the terminal stage. Further research for more evidences and effective communication based on the concerns of patients and their families found in this study can be helpful to the decision-makings for appropriate use of ANH.

D.16 完成檢誤日期:2003-12-09
D.17 預定釋出日期:2003-12-31
D.18 初次釋出日期:2004-01-09
D.19_1 最新版釋出日期:2004-01-09
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10.6141/TW-SRDA-E90070-1
http://efenci.srda.sinica.edu.tw/webview/index.jsp?object=http://efenci.srda.sinica.edu.tw:80/obj/fStudy/E90070
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