2016-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646864摘要：背景:安寧療護的目的在協助末期病人達到善終。研究發現，人工營養水分議題及抗生素的使用為臨床照護最大的倫理議題。末期癌症病人由於意識不清，吞嚥困難等因素，導致無法經口進食。是否要給人工營養及水分，實在考驗醫護人的醫療知識與倫理觀念。健康保險研究資料庫的研究顯示，我國末期照護的最大花費還是在於點滴注射。由於目前缺乏大型前瞻性的研究，因此如何經由實證研究，對於非常末期的病人，證明人工水分的給予無助於症狀的改善，死亡品質的提升及生命的延長，應是深具臨床與教育意義，並能提供政府作為政策規劃的參考。研究方法:將以多中心前瞻式世代研究法進行此為期三年的研究。本研究探討台灣癌症末期病人給予人工水分對存活、症狀緩解、與死亡品質的影響。主要結果變項為存活時間，而次要結果變項是症狀緩解、病人死亡品質、及給予人工水分可能出現的副作用。本研究在估計非劣試驗所需總樣本數為1,238人。研究工具為「死亡品質問卷」及「症狀評估表」。 將使用Cox’s proportional hazards modelwith time-dependent covariates，來比較（1）給予人工水分與（2）不給予人工水分對癌末病人的存活時間之影響。預期結果:本研究證實給予人工水分與無接受人工水分兩組癌症末期病人的存活時間、症狀改善及死亡品質相當。<br> Abstract: Background:The ultimate goal of palliative care is to achieve good death for the terminally illpatients. Research has found that the issues of artificial hydration and use ofantibiotic are the two most prevailing ethical dilemmas. Due to disturbedconsciousness and swallowing difficulties, many terminally ill patients are unable tohave intakes. Whether to give artificial hydration or nutrition is challenging themedical knowledge and ethics of medical personals. Despite the fact that artificialhydration has decreased for the past years as the result of education, data from theNational Health Insurance revealed that artificial hydration ranks the top expenditurefor the terminally ill. Therefore, from evidence- based point of view, we want toconduct a large-scale, prospective study to prove that to the very terminally illpatients, artificial hydration will not prolong life, improve symptoms and enhancequality of dying. We believe the study result will contribute the filed of palliativecare serving as clinical guideline and health policy.Method:We will conduct a multicencer, prospective cohort study, involving fourhospitals all over Taiwan for three years. We aim to observe the effect of artificialhydration to the survival, symptom improvement and quality of dying for theTaiwanese terminally ill patients. The primary outcome is the survival and secondaryoutcomes are symptom improvement, quality of dying and side effects as theconsequence of artificial hydration. We applied non-inferiority trial and theestimated sample size is 1,238 persons. Research tools are “Quality of Dying andDeath”, “Symptom Evaluation” questionnaires. We will apply Cox’s proportionalhazards model with time-dependent covariates to compare the effect of artificialhydration between the hydration group and non-hydration group.Expected results:Our study will prove there is no difference regarding to survival, symptomimprovement and quality of dying between artificial hydration and non- hydrationgroups for the terminally ill cancer patients.安寧療護倫理困境人工水分存活死亡品質hospiceethical dilemmaartificial hydrationsurvivalquality of dying