2010-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646801摘要：提供符合末期病人需求與期望的照顧是末期照顧的核心目標，也是醫療體系必要之倫理觀。本研究第一年目的為了解目前台灣地區民眾的末期照顧態度及期望，並比較家庭醫師的認知，以作為將來末期照顧醫病間良好溝通之參考。第一年預計抽樣調查有關：1)家庭照顧能力及困難所在，2)末期照顧偏好場所，3)告知真相的期望及4)末期治療策略等議題的態度及相關因素。研究母群體為全國社區醫療群家庭醫師與其所照護的民眾為對象，針對所照護民眾在上述議題的選擇傾向，家庭醫師也進行預測，測其一致性。國內安寧緩和醫療目前已擴展到非癌症安寧療護。收集常見臨床困境及解決策略，制定合乎我國民情的指引，以保証服務品質，實為當務之急。本研究第二、三年即據此有下列研究目的與工作項目：1)調查國內安寧療護機構常遭遇的臨床與倫理困境及其影響因素，並收集各機構解決策略，2)以醫學倫理架構探討上述課題的內涵訂定符合國情之照顧原則，3)廣徵專家意見制定國家級之指引。本研究將以問卷訪查，專家諮詢及文獻覆查，完成以上之目的及工作項目。三年研究計畫整體預期目標為提供末期醫病溝通之教學指引與醫療體系政策推展實證基礎。同時藉由末期照顧臨床指引，協助解決倫理困境，全面提昇我國末期醫療照顧品質及學術專業性，以臻先進國家之水準。<br> Abstract: A questionnaire survey nationwide was carried out for the general public in the communities inTaiwan regarding to 1) readiness of the family to provide care to terminal ill patients at home, 2) thepreferred place for terminal care and meeting death, 3) truth disclosure for cancer and 4) therapeuticstrategy for terminal cancer…etc. In the meantime, a comparison was made between thepatients‘ preference and family physicians’ estimation. The findings of the study in the first year canbe anticipated to suggest a better community care and the issues including death education、truthdisclosure and advance directives in the terminal care. Nevertheless, better communication betweenpatients and physicians about terminal care could be enhanced.There are many clinical and ethical dilemmas occurred in hospice care unit that puzzleprofessionals and influence the endeavor for the good death of terminal cancer patients. To establishthe guidelines and regulations for the hospice care is also believed to be important for hospicedevelopment in Taiwan. According to above reasons, the study in the second and third years will beconducted for those purposes include: (1) to survey the frequency and causes of the puzzled issuesand ethical dilemmas in the hospice nationwide, (2) to investigate the contents of above issues anddilemmas based on the ethical principles and seek out the solutions for that issues, (3) to proposeappropriate guideline and regulations for the hospice care which are suitable in Taiwan. The period ofthis part study will be two years. The first work is to conduct questionnaire survey and field study.Then, followed by a serial of counseling meeting to reach the purposes of this study. Following thenationwide survey to palliative care professionals, we also survey the bereaved families about themost puzzling issues, such as “ difficult to provide psychospiritual care ”, “family refused dischargeplan for patients” and “family refused to tell the patient truth ”..etc To investigate the meaning ofthese issues, seek out better solution creatively and establish the guideline will be the main purposesin the second and third years. Anticipating outcome will be the promotion of quality of end-of-lifecare, and the academic performance in Taiwan.末期病人真相告知倫理困境緩和醫療terminal ill patienttruth tellingclinical dilemmahospice/palliative care