背景與目的：
依文獻統計呼吸器依賴患者約有60%喪失認知溝通能力，生活起居完全需他人協助，照護上是家屬很大負擔。民國89年安寧緩和條例立法，歷經多次修法，102年修正條例為：需由二位相關專科醫師診斷確為末期病人，意識昏迷或無法清楚表達意願時，可由其最近親屬簽署「終止或撤除心肺復甦術同意書」。回溯從民國100年健保局統計資料發現，呼吸器使用病患醫療花費是繼癌症之後排名第二，因此本研究想探討呼吸器依賴患者家屬，對安寧緩和醫療的了解情形、接受度與執行層面問題，因此本研究搭配知識、態度、行為理論模式來探討這些問題。

研究方法：
本研究採橫斷式研究設計，參考國內外文獻與研究者臨床經驗，自擬結構性問卷收集資料。知識、態度、行為量表信度Cronbach`s α值為：0.918、0.726、0.812；建構效度（Construct Valdity）KMO值為：0.871、0.812、0.764均達理想值。收案其間為102年4月至102年9月止；對象為高屏地區呼吸器使用大於21天，年齡大於17歲之呼吸器依賴患者，以ㄧ對ㄧ方式進行匿名式收案調查。問卷內容包含呼吸器依賴患者家屬對安寧緩和醫療知識量表、態度量表、行為量表，以及家屬基本資料表、病人基本資料表。以描述性分析、獨立樣本T檢定、單因子變異數分析、皮爾森相關係數及複迴歸方法分析資料。

研究結果：
共發出370份問卷，回收356份（回收率96.21%）問卷，有效樣本數為348份。呼吸器依賴患者平均年齡為71-85歲，家屬年齡平均為46-60歲；病患意識不清楚者家屬在知識上有較高認知、態度上較正向、行為執行度上較高。各量表得分意向分析上，知識與態度得分皆高於行為，顯示即便具有高的相關知識與接受的態度，當面臨實際執行撤除維生系統決澤時，家屬的意願仍然不高。相關分析結果：家屬對安寧緩和醫療知識愈高，對安寧緩和醫療態度愈正向，行為執行度愈高。複迴歸分析結果:「與病患關係」、「家屬職業」、「病患意識程度」、「醫院等級」等是知識構面重要影響因子；「家屬行為意向」、「家屬知識意向」、「家屬與病患關係」等是態度構面重要影響因子；「家屬與病患關係」、「家屬年齡」、「是否屬於末期病患」、「入院前是否與家人同住」、「呼吸器天數＞365天」、「與病患關係」、「家屬態度意向」等是行為構面重要影響因子。

結論：
呼吸器依賴患者家屬對於安寧緩和醫療概念已較成熟，在法規規定上認知較較模糊；以及家屬在面對疾病末期時，執行安寧緩和醫療行為，如撤除維生系統執行度較不足。希望能提供給相關單位參考，做為未來安寧療護的努力方向。

Background and Aim
The current evidences had shown that sixty percentages of ventilator dependent patients had loss communication ability and the daily activities were totally dependent. Caring such ventilator dependent patients is a heavy loading for families. Hospice palliative medicine law was legislated in 2000. In 2013, the law was adjusted and defined that only one relative can decide to sign permit of withdrawal therapy if two doctors had declared that the patient was incurable, comatose consciousness. Tracing back the 2011 national health insurance database, the cost ranking of ventilator dependent patients was the secondary. The aim of this study was to explore the understanding, acceptance and performance of ventilator dependent patients toward hospice palliative medicine law. Through knowledge, attitude and behavior model, we can analyze these problems.

Methods
This is a cross section study. We designed the structured questionnaire based research articles, clinical experience.Knowledge, attitude and behavior scale (Cronbach`s α value：0.918、0.726、0.812；Construct Valdity KMO：0.871、0.812、0.764) reach the ideal value. Patients who had ventilator dependent for more than 21 days and age >17 years old were included from 2013-4~ 2013-9. Questionnaires were collected blindly. The contents of questionnaires are the ventilator dependent patients’ families’ knowledge scale, attitude scale, behavior scale toward hospice palliative medicine and family and patients themselves demography data. Statistical analyses were including Descriptive Statistics Analysis, Independent samples T-test, One-way ANOVA, Pearson`s Correlation Coefficient and Multiple Regression Analysis.

Results
We totally provides 370 questionnaire copies and the recycling effective questionnaire were 356 copies. The effective questionnaires were 348 copies. The ages of ventilator dependent patients were 71~ 85 years old and the ages of families were 46-60 years old. The families of comatose patients had higher knowledge level and positive attitude and higher performance. Among different scales analysis, the scores of knowledge, attitude are higher than behavior. That mean the willing to agree withdrawal therapy is low even the families had better knowledge and positive behavior of hospice palliative medicine. In addition, the better of families’ knowledge of hospice palliative medicine, the more positive attitude and performance toward hospice palliative medicine. Regression models had shown that the relationship of patients, occupation of families, patients’ consciousness level, hospital level are the important factors of knowledge dimension. Families’ behavior attitude, knowledge attitude and relationship between patients and families are the major factors of behavior dimension. The behavior dimensions important factors are relationships, families’ ages, terminal stage of disease, living with family before admission, the durations of ventilator> 365 days and families’ attitudes.

Conclusions.
The ideas toward hospice palliative medicine of ventilator dependent patients’ families are more matured than before but the cognition is obscure. The performance of hospice palliative therapy is still inadequate when families face the terminal disease stage. Our results can provide the further direction of hospice palliative medicine.

論文審定書................................................................................................................i
誌謝..........................................................................................................................ii
中文摘要..................................................................................................................iii
ABSTRACT...............................................................................................................v
目錄.........................................................................................................................vii
圖次........................................................................................................................viii
表次.........................................................................................................................ix
第一章 緒論..........................................................................................................1
第一節 研究背景及動機............................................................................................1
第二節 研究目的......................................................................................................7
第二章 文獻查證...................................................................................................8
第一節 呼吸器依賴患者的流行病學與現況................................................................8
第二節 呼吸器使用之負擔.......................................................................................10
第三節 呼吸器依賴患者與安寧緩和療.....................................................................13
第三章 研究方法.................................................................................................16
第一節 研究設計...................................................................................................16
第二節 研究架構...................................................................................................16
第三節 研究問題...................................................................................................18
第四節 研究假設...................................................................................................19
第五節 研究對象與資料收集................................................................................ 20
第六節 研究工具問卷設計.....................................................................................21
第七節 信效度分析...............................................................................................30
第八節 資料處理與統計分析.................................................................................38
第九節 研究對象權...............................................................................................39
第四章 研究分析與結果......................................................................................40
第一節 人口學屬性特質分析.................................................................................40
第二節 呼吸器依賴患者家屬知識、態度、行為意向屬性特質分析.........................47
第三節 呼吸器依賴患者家屬知識、態度、行為意向相關性分析.............................52
第四節 呼吸器依賴患者、家屬人口學屬性與知識、態度、行為意向差異性分析....56
第五節 呼吸器依賴患者家屬知識、態度、行為意向與自變項之迴歸分析...............72
第六節 假設驗證...................................................................................................76
第五章 討論與建議...............................................................................................78
第一節 呼吸器依賴患者和家屬人口學特質............................................................78
第二節 呼吸器依賴患者家屬對安寧緩和醫療之知識、態度、行為意向現
況與相關分析........................................................................................79
第三節 呼吸器依賴患者家屬對安寧緩和醫療之知識、態度、行為意向差
異性析...................................................................................................82
第四節 呼吸器依賴患者家屬對安寧緩和醫療之知識、態度、行為意向預
測變項分析..........................................................................................82
第六章 結論與建議...............................................................................................83
第一節 結論..........................................................................................................83
第二節 研究貢獻...................................................................................................83
第三節 研究建議...................................................................................................83
第四節 研究限制...................................................................................................85
參考文獻.................................................................................................................86
一、英文文獻.................................. ...................................................................... 86
二、中文文獻........................................ .................................................................87
附錄
一、人體試驗委員會核准同意函..............................................................................90
二、專家名冊..........................................................................................................92
三、內容效度評分表...............................................................................................93
四、專家內容效度評分結果與建議..........................................................................98
五、問卷...............................................................................................................104

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