2011-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/657372摘要：台灣「安寧緩和醫療條例」立法通過迄今逾十年，政府與專業學會雖積極地推展相關政策，但落實於臨床實務的仍有限，使得病人的自主性仍未受到保障，由「家屬代為簽署DNR 同意書」所造成的末期醫療決策困擾仍層出不窮。國內有系統地探討預立照護計畫（advance care planning; ACP）之相關研究也付之闕如，故加強此方面研究並建構與實施ACP臨床實務模式以提昇末期醫療照護品質，實乃當急之務。本研究擬針對癌症病人，進行三年期縱貫性介入之實證研究設計，期能建構出以理論為基礎且符合華人文化於家庭脈絡下尊重病人自主性之ACP臨床實務模式，協助病人達到善終。第一年：擬以系統性文獻查證、統合分析及德爾菲研究法，確認出ACP的「組成要素」、重要「過程與結果」指標及其介入成效，進而找出台灣執行ACP 的可行策略。據以發展出具有理論基礎之四階段「ACP-照護模式」。第二年：依第一年所建構之四階段照護模式，製作各階段實用之介入處置輔助工具與標準實施流程。採雙組前後測準實驗研究設計，以評價實施「ACP-照護模式」之成效。第三年：持續評值此照護模式介入成效，以建構出「台灣癌症病人ACP-照護模式」外; 舉辦專家會議進一步評價此臨床實務模式之可行性，制定「ACP-臨床實務模式」指引與學習手冊; 並透過工作坊培育種子師資。以真正落實安寧緩和醫療條例的立法精神，尊重病人之末期醫療決策的自主性，進而提升其生活品質以達善終。<br> Abstract: The Hospice-Palliative Care Act has been legalized for ten years in Taiwan. However, it still be recognized not to be helpful in the promotion of the autonomy of patients which might be due to the difficult to practice in our cultural context. How to solve this clinical dilemma and to establish an appropriate model to promote the autonomy of patients and the care quality will be very important work in the near future.This 3-years project has integrated the several quantity methods and designed with longitudinal and interventional process to establish the “advance care planning (ACP)” care model of respecting for cancer patient’s autonomy in our family-oriented cultural context and to evaluate the effect upon the quality of end of life care. The first year in the project will use the systematic review, meta analysis, and Delphi research method to find the components of ACP and their audit items of process and outcome. Otherwise, to investigate the current situation in Taiwan is another work. According to the finding, to develop the theoretical based practice models of ACP. The second year will work include three-holds: (1) design the teaching materials for ACP model, (2) perform the pilot study, (3) evaluate the outcome of interventions with our established ACP model. The third year’s and also the important year will evaluate the outcome of interventions with our established model, otherwise to hold up the workshop to modify and confirm the model, and spread it to other institutes for general public. We anticipate the results will be helpful to construct the clinical practice guideline of ACP and Hospice-Palliative Care Act, eventually to promote the autonomy and care quality of patients.預立照護計畫本土化病人自主