非安寧療護醫師對安寧療護認知及轉介之研究

NHUIR > College of Humanities > Department of Life-and-Death Studies > Disserations and Theses(M. A. Program in Life-and-Death Studies) > Item 987654321/20850

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Title:	非安寧療護醫師對安寧療護認知及轉介之研究
Other Titles:	A study on non-hospice physician's cognition & referral of hospice care
Authors:	蕭麗卿
Contributors:	生死學研究所蔡昌雄
Keywords:	全民健康保險;安寧療護;認知;轉介;癌末病人 National health insurance;hospice care;recognition;transfer;cancer terminal patients
Date:	2001
Issue Date:	2015-05-18 15:14:07 (UTC+8)
Abstract:	本研究藉由紮根理論，探索非安寧療護醫師對安寧療護的認知及影響轉介病人到安寧療護之相關因素。針對雲嘉南地區有辦理全民健康保險住院論日計酬之醫院，篩選患癌率較高之科別的醫師為研究對象進行深度訪談，受訪醫師首先認為安寧療護應該在癌症治療計劃時即須提供，而非等到癌症末期才接受安寧療護之照護；其次認為安寧療護全人照護理念尚未完全建立，應結合社區與第一線醫師提供整體性之醫療照護模式；第三、目前安寧療護侷限在大醫院及院內服務，讓人感覺僅照護到身體的需求，心靈部分較流於形式；第四、不認為安寧療護病房的醫師會讓病人得到更好的照護；第五、由於近年來醫療科技及藥物的發明，提高癌症的治癒能力，受訪醫師認為將病人轉入安寧療護，如像將病人轉入等死的地方，猶如放棄病人，因此心中充滿了不捨，所以大部分的醫師會將病人醫治到生命如燈滅，才將病人轉介安寧療護。目前全民健康保險的給付以服務量為給付的依據，較難誘導醫院將安寧療護納入整體醫療需求規劃，以分擔健保財務的責任。又醫院對醫師以服務量計薪，在人性自利下，將影響醫師轉介安寧療護的意願。另外全民健康保險對住院超過十六天的安寧療護以給付標準的60%支付，受訪醫師表示，這樣一來醫院會將病人轉至無辦理安寧療護的醫院繼續住院，是否這是造成病人返回一般照護較高比率的原因，值得再觀察。由於非安寧療護醫師對安寧療護執行方式仍不認同，如何尋求認同是很重要的，未來除加強宣導安寧療護的觀念外，建議辦理案例分享或實務觀摩，以增加一般醫師認識安寧療護的機會。另全民健康保險支付方式，可以引導醫療政策，使安寧療護推廣更加順利。 By grounded theory, we explore those factors that affect the non-hospice physician’s (NHP) recognition to hospice care and their intention to transfer the patients to hospice ward. We choose some hospitals in the southern district of Taiwan. They provide hospice services pay per day by the National Health Insurance (NHI). Then we select some NHP that care much cancer patients from above hospitals, and interview them comprehensively. Results reveal as below. At first, these NHP think it is necessary to provide hospice care in the initial phase of cancer treatment, but not till the terminal phase. Secondary, because of lacking of holistic care conceptual model now, they advise to adopt the model to combine primary care physicians into the integrative care service. Third, hospice services, which now are all provided in the hospitals, focus on the body care and little on mind or soul. Fourth, they think hospice physicians don’t care better. At last, they believe that there will exist more medical or therapeutic improvement to cure more cancers, and it seems to give patients up at transferring them to hospice ward. So NHP feel sorrow and only to do that till there is really no possibility to treat the patients better. It is difficult to recruit more medical service providers to integrate hospice care into their service plans to share the responsibility of the NHI finance by the recent reimbursement system of Taiwan NHI. It is also not easy to encourage NHP to transfer their patients to hospice wards, especially when hospitals pay their physicians on their service volumes. Otherwise, NHI discounts the reimbursement 60% when the patients stay at the hospice ward for more than 16 days, and it will make the care providers transfer their patients to non-hospice hospital at that time. We advise to check whether that resists the adoption of hospice care. Under the weak confidence of NHP to hospice care, it is very important to encourage them to access relevant hospital knowledge or cases by sharing the hospice care experience. Of course, we should not forget the reimbursement of NHI is also the major cause to promote the hospice care.
Appears in Collections:	[Department of Life-and-Death Studies] Disserations and Theses(M. A. Program in Life-and-Death Studies)

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