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E94028
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善終:有慢性病的老人和其家屬的觀點
Perspective of Good Death in Older Adults with Chronic Illness and Their Families
1.吳麗珍
1.Lee-jen Wu
1.長榮大學護理系
1.Department of Nursing, Chang Jung University
001,002,003,004
1.長榮大學護理系
1.Department of Nursing, Chang Jung University
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1.行政院國家科學委員會
1.National Science Council
A.14 計畫執行期間(起):2005-12-01
A.14 計畫執行期間(訖):2006-07-31
A.16 收到日期:2006-12-01
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南部地區60歲以上患有慢性病的人和其家屬

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C.2 聯絡日期:2006-12-05
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1.長榮大學護理系
1.Department of Nursing, Chang Jung University
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三年後公開

C.7 資料公開日期:2009-08-01
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1.生命末期
2.自主權
3.家屬
4.善終
5.慢性病老人
1.Family
2.Good Death
3.Older Adults with Chronic Illnesses
4.Patient Autonomy
 人口的老化是整個世界的趨勢,近年來西方國家鑑於多數老人罹患有慢性病,而且他們的死因主要是無法控制的慢性病和其併發症,因此將緩和醫療和善終的觀念 應用在老人慢性病生命末期的醫療照護上。在台灣,家屬通常決定老人生命末期是否繼續接受積極的治療,但是他們的決定不一定是老人的意願,也可能沒有和老人 溝通過。

這個研究計畫的主要目的是要了解患有慢性病的老人和其家屬對“善終、生命末期治療和病人自主權”的看法。這個研究以立意樣本,收集到94對居住在台灣 南部60歲或以上患有慢性病的老人和家屬的資料。在病人自主權上,大多數的老人(82%)和家屬(77%)都主張要讓病患知道癌症末期的診斷。54%的老 人,19%的家屬認為讓病人做醫療決定不會增加病人的負擔。84%的老人認為家屬應該尊重病人的決定。這些資料顯示出老人比一般人想像的更注重病人的自主 權,希望在醫療上有更多的決定權。在維生醫療措施的使用上,病人和家屬均傾向於不再使用侵入性的治療,例如手術或心肺復甦按摩,特別是失智或陷入不可逆的 昏迷狀態時。在善終上,老人認為最重要的是安詳無疼痛和不刻意延長生命的死亡,只有21%認為靈性需求的滿足很重要。這個研究顯示尊重病人自主權是一般 人,包括老人,的意願,談論死亡不是必然的禁忌。

As the world population grows older, death is occurring later in life. Many older adults suffer from serious chronic illnesses before dying from complications of these illnesses. Although medical technology has made it possible to extend further the lives of older adults, these efforts sometimes result in great suffering before death. Thus, gerontologists in Western countries have recently begun to advocate palliative care and good death in the care of older adults with severe chronic illnesses. In Taiwan, the family usually makes decisions regarding end-of-life treatment for an older patient, but these decisions may not necessarily be consistent with the patient’s wishes, especially if the wishes have not been conveyed. The purpose of this study is to explore perceptions of good death, end-of-life care decisions, and patient autonomy in older adults with chronic illnesses and their families.

A convenience sample of older adults with chronic illnesses and their families was drawn from southern Taiwan, of which 94 pairs completed the interview. The majority of the older adults and their families believe that a terminal diagnosis should be disclosed to the patient. Fifty-four percent older adults versus 19% of family members (p < 0.01) believe that making health care decisions is not a burden to the patient. Fifty-six percent of older adults versus 39% of family members (p < 0.05) believe that patients have the right to terminate their lives if there is no cure. Regarding to life sustaining treatment, both older adults and families would forgo invasive treatment such as surgery or CPR if cognitive function was impaired or the patient was in an irreversible coma. Older adults considered dying peacefully, no pain, without artificially prolonging life, short dying period, and love ones present as components of a good death. Only 13% rated remaining mentally alert and only 21% rated fulfilling spiritual needs as essential in a good death. This research found that older adults value patient autonomy and patients’ rights in decision making. Dying peacefully without artificially prolonging life is a part of their wishes for a good death.

D.16 完成檢誤日期:2008-10-22
D.17 預定釋出日期:2009-08-01
D.18 初次釋出日期:2009-10-14
D.19_1 最新版釋出日期:2009-10-14
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10.6141/TW-SRDA-E94028-1
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