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博碩士論文 etd-0827109-173617 詳細資訊
Title page for etd-0827109-173617
論文名稱
Title
癌症病患簽署不施行心肺復甦術同意書之分析研究
The Related Factors Toward Terminal Cancer Patients Do-Not-Resuscitate
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
64
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2009-06-13
繳交日期
Date of Submission
2009-08-27
關鍵字
Keywords
心肺復甦術、不施行心肺復甦術意願書、維生治療
Cardiopulmonary resuscitation, Do-Not-Resuscitate, Life sustaining treatments
統計
Statistics
本論文已被瀏覽 5789 次,被下載 7
The thesis/dissertation has been browsed 5789 times, has been downloaded 7 times.
中文摘要
癌症位居國人十大死因之首已經十幾年,相關治療的進步給罹患癌症的病患與其家屬帶來無限的希望與鼓舞,國人平均餘命的延長及死亡率的下降,使得病患與其家屬面對死亡的態度相對積極,希望透過各種先進設備與藥物能儘量延長其親人的生命,而生命盡頭使用維生治療延長生命或預立DNR維持生命末期生活的品質與尊嚴,是醫療人員與病患及家屬的兩難,因此本研究的目的是探討癌症末期病患及家屬簽署不施行心肺復甦術同意書的各種情況,希望能分析出影響其簽署時機的相關因素。
以南部某區域教學醫院之癌症末期病患或家屬簽署的「不施行心肺復甦術」同意書共80份為例,回溯其病歷紀錄並分析探討各相關因子,是否影響同意書簽署的時間。
研究結果顯示,多數癌症末期病患與家屬簽署「不施行心肺復甦術」同意書的時間距離病患死亡的時間很近,大於二週的僅佔12.5%,有55%病患與家屬於死亡前五天才簽署同意書,三成的病患與家屬在簽署同意書後6-14天死亡,更有兩成(21.25%)病患與家屬於死亡當天才簽署同意書;病患的年齡、性別、原發癌症的種類、是否有肺或肋膜的轉移、病患是否曾接受癌症相關治療治療對簽署時間的影響並沒有統計上的差異,在推論性統計類別變項的卡方統計分析中發現教育程度、病患或家屬簽署同意書時是否病危以及止痛藥使用的情況等三項因素與病患簽署的時間有顯著相關。有72.5%的病患教育程度為小學、國中與高中程度的佔18.75%,八成的病患於病況危急時才簽署同意書,國小(含)以下學歷的病患簽署DNR後至死亡總天數大於6天者有32位,國中學歷(含)以上者僅有4位(p值=0.003);53.75%的病患於簽署DNR同意書時曾使用中低效度以上的類鴉片止痛藥,其中包括25%病患使用嗎啡類止痛藥,有使用止痛藥物病患簽署DNR後至死亡總天數大於6天者有18位,少於無止痛藥物使用的26位(p值=0.011);病危情況下簽署DNR後至死亡總天數大於6天者有42位,小於6天者有23位具顯著差異
(p值=0.000)。
建議加強醫護同仁及一般社區居民對安寧療護的認識,醫療人員關於DNR 的觀念有賴透過教育予以釐清,醫護同仁必須更深入瞭解癌症末期病患的身心狀況,提供適當的關懷與協助,協助獲得更好的生活適應,並找到生命的意義與價值,安然面對人生的終點。
Abstract
Cancer was the most common cause of the death in Taiwan in the past two decades. The recent advanced improvements of cancer treatment took endless encouragements and hopes to patients and their families, so they intended aggressively while dealing with the issue of death because of the decline of mortality rate and prolonged mean lifespan. It was difficult for families and doctors to decide whether to prolong life by life sustaing treatments (including cardiopulmonary resuscitation) or to sign Do-Not-Resuscitate (DNR) consent for terminal cancer patients .We want to analyze the related factors toward terminal cancer patients DNR and point out some ones correlated closely with the time of signing consent in this restrospective research.
We corrected 80 DNR consents signed by terminal cancer patients or their families from one general teaching hospital in south Taiwan and analyzed factors toward the time of signing consents.
Results of this study showed that the time of signing consents was very close with that of their death . Only 12.5% of the patients with survival more than 2 weeks after signing DNR consents, 55% of the patients or their families did not sign the consents until five days before their death, 30% of the patients died in 6-14 days after signing DNR consents, and there were even more twenty percent (21.25%) of the patients died in the day of which the consents were just signed by their families. The patients’age, gender, kinds of their primary cancer, whether the pulmonary or pleural metastasis were present or not, and the treatments of these patients had no significant correlations with the time of signing DNR consents. Only three factors including of education level of patients, whether the patients’illness was critical while signing consents and kinds of patients’painkiller use contributed to the time of DNR signing significantly in this research. 72.5% of these patients had the degree for the primary school, and 80% of the patients or their families signed the consents just when the patients’illness was critical. There were 32 patients with degree of the primary school and only 4 with degree of the junior high school within the patients wih survival more than 6 days after signing DNR consents (p value =0.003); There were 53.75% of the patients had ever used opioid painkillers while siging DNR consents, 25% of them had even received morphine for pain control. For the patients with survival more than 6 days after signing DNR consents, there were 18 patients prescribed opioid painkillers, and 26 patients without taking painkillers that meaned significant difference (p value =0.011); For the patients with critical illness while signing DNR consents, it meaned statistic difference for that 42 patients got survival more than 6 days and 23 patients with survival less than 6 days. (p value =0.000).
We highly suggest to inforce the knowledge of hospice care to people in community and the colleagues of doctors and nurses by any kinds of education and introduction. We all need to pay more attentions to psychiatric status of terminal cancer patients and supply adequate help and care for them, so we could all get more close to meanings of human life.
目次 Table of Contents
論文提要 ………………………………………………………………………… i
中文摘要…………………………………………………………………………….i
英文摘要…………………………………………………………………………… iv
誌謝詞……………………………………………………………………………… v
目錄………………………………………………………………………………….vii
表目錄……………………………………………………………………………….ix
圖目錄……………………………………………………………………………… x
第一章 緒論
第一節 研究動機 1
第二節 研究目的與問題 4
第三節 名詞界定 5
第二章 文獻探討
第一節 安寧緩和醫療的相關概念 6
第二節 臨終病患之照護 11
第三節 死亡態度的探討 15
第三章 研究方法
第一節 研究架構 20
第二節 研究樣本 21
第三節 研究流程 21
第四節 變項的說明 24
第五節 資料處理與統計方法 27
第四章 研究結果
第一節 樣本的描述性統計分析 29
第二節 樣本的推論性統計分析 33
第五章 討論
第一節 病患基本資料之分析 38
第二節 疾病相關資料之分析 38
第三節 醫護人員對「不施予心肺復甦術」相關認知及其相關因素 39
第六章 結論、研究限制與研究建議
第一節 結論 40
第二節 研究限制 41
第三節 研究建議 41
文獻參考
一、中文文獻 43
二、英文文獻 45
附錄一、安寧緩和醫療條例 48
附錄二、安寧緩和醫療條例施行細則 52









表目錄
表3-1:各種變項的說明 24
表4-1:樣本的描述性統計(依變項和自變項病患資料) 30
表4-2:樣本的描述性統計(自變項疾病相關資料) 31
表4-3:樣本的描述性統計(自變項DNR 簽署內容) 32
表4-4:獨立樣本t 檢定分析 34
表 4-5:單因子變異數分析-止痛藥物使用情況與簽署DNR後之存活總日數
薛費法 36
表 4-6:單因子變異數分析表 教育程度與簽署DNR後之存活總日數薛費法 36
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