Good Death Assessment of Geriatric Patients with Terminal Cancers
Resource
安寧療護 v.10 n.1 pp.13-23
Journal
安寧療護,v.10
Journal Issue
n.1
Pages
13-23
Date Issued
2005
Date
2005
Author(s)
TSENG, UN-JU
CHIU, TAI-YUAN
HU, WEN-YU
CHENG, SHAO-YI
YAO, CHIEN-AN
CHEN, CHING-YU
Abstract
癌症已成為近二十年來台灣地區死亡原因之首位，而其中老年人佔一半以上，因此了 解老年癌末病人善終情況及探討安寧緩和醫療照顧成效，為老人醫學重要課題。因此 本研究目的有：1.探討台大醫院緩和醫療病房老年病人的善終情形，2.比較老年病人 組與非老年病人組在善終指標評分上的差異，及分析可能的原因。本研究對象為2003 年4月至2004年3月一年期間374位在台大醫院緩和醫療病房過世的癌末病人，以團隊 會議討論方式，進行「善終指標」評估與「善終服務」的評價。「善終指標評估」包 含1.了解自己死之將近，2.心平氣和接受，3.後事交待安排，4.時間恰當性，5.去世 前三天舒適性。「善終服務評價」包含1.身體照護，2.自主性，3.情緒穩定度，4.溝 通，5.生活連續性，6.結束等項目。結果顯示老年癌末病患較不了解自己死之將近(t =3.24, p<0.01)，且在過世時較不能心平氣和接受(t=1.99, p <0.01)。另外常因家 屬刻意隱瞞病情因而缺乏照護自主性，因此是在『病人的自主能力得到尊重』與『病 人參與照護意願得到尊重』兩個項目均較低(t=2.07, p<0.05; t=2.26, p<0.05)。結 論為病情告知影響善終分數，為重要老年癌末照護課題。 The cancer has already become the leading cause of death in Taiwan since 1971, and the majority is aged people. Therefore it is important to understand the good death of geriatric patients with terminal cancer and its influence factors. The objectives of this study were to assess the score of good death of terminal cancer patients, to compare the difference of the score of good death between geriatric and non-geriatric patients and to investigate the possible influence factors. A total of 374 terminal cancer patients died between April 2003 and March 2004 had been enrolled. We assessed "the index of good death" and "the services for good death" for each patient with weekly team meetings. "The index of good death" included the assessment of awareness, acceptance, propriety, timeliness and comfort before death. "The services for good death" included the assessment of care, control, composure, communication, continuity and closure. The results showed that geriatric terminal cancer patients had lower scores in the awareness of and acceptance of the imminence of death. Besides the geriatric patients intended to loss the lost of control and autonomy in decision makings before death because family didn’t tell the truth. In conclusion, truth telling is an important dilemma influencing the good death and further investigation will be worthwhile.
Subjects
緩和醫療
老年
善終
hospice
palliative care
geriatric
SDGs