我國一年死於末期癌症病患約近四萬人，末期病人除了身體、心理、靈性、社會等方面受到極大痛苦外，家屬照顧病人也背負著極大的責任與壓力，如何協助病人及家屬選擇安寧照顧模式，適時能減輕病患於瀕死過程中的痛苦，改善末期病人之症狀困擾程度及提昇其生活品質，肯定生命存在的意義，讓瀕死病人有尊嚴走完人生最後一程。

設計：
本研究目的是為探討民眾對於安寧療護服務內容及選擇安寧緩和醫療的意願。本研究採調查研究方法（Survey Method），便利取樣方式(convenience sampling)，採用結構式問卷收集資料。安寧緩和療護問卷量表信度Cronbach’s α 值為約0.635（Cuieford 1965 ；0.35≦α≦0.70中信度）；KMO值為0.730；專家內容效度(CVI)為0.86，信效度均達理想值。樣本對象為南部地區民眾採便利取樣方式進行問卷調查。樣本共發出500份、回收393份（回收率78.6%），有效樣本研究採調查研究方法（Survey Method）。問卷內容包括五部份：「填答者基本資料表」、「安寧緩和療護認知」、「病情告知及醫療處置」、「選擇安寧療護」、「安寧療護常識」，所得資料以SPSS Windows 19.0 版進行複選題次數分析、複選題交叉分析、描述性統計分析、獨立樣本t 檢定、單因子變異數分析、皮爾森相關係數進行統計分析。

結論：
研究結果顯示：（1）民眾對於安寧療護認知愈清楚，其選擇安寧療護意願愈高，本次研究中，將近約92.6％的民眾有聽過安寧病房及安寧療護，對於安寧療護提供病人身、心、靈等照護模式表認同（2）近30.8％民眾不知道何謂『預立選擇安寧緩和醫療意願書』，此外有關「醫療委任代理人」近21.6％的民眾從未聽過。（3）近44％民眾認為於意識清楚時決定醫療處置為很重要，另外約17％民眾尚未想到或考慮到於意識清楚時預立醫療處置計劃等議題（4）約有38％男性及46％女性民眾表示不瞭解安寧療護所提供的服務內容，針對以上調查結果提供給安寧療護政策提供者及醫療照護者參考，做為未來推動安寧療護醫療資源及宣導活動的參考依據。

Background
Every year nearly 40,000 patients die of cancer in Taiwan. Not only are the terminally ill tortured psychologically, spiritually, socially, and physically, their family caregivers are burdened with responsibility and pressure. Assisting patients and families in selecting hospice care eases anxiety in patients during the dying process, relieving some of the disturbance caused by symptoms of being terminally ill. In addition, this enhances their quality of life and enables the terminally ill to meet the end of their life with dignity.

Design
This study explored the public's perceptions of hospice care and hospice services, as well as their willingness to receive hospice care and palliative medicine. The survey adopted a survey method and convenience sampling by using a structured questionnaire to collect the information. The concept and selection reliabilities of the hospice questionnaire were 0.635. Their KMO was 0.730, and their expert validity (CVI) was 0.86. The questionnaire reached the ideal value of reliability and validity. The data for this study were collected from convenience sampling people in Southern Taiwan by using a predesigned questionnaire, and 393 of the 500 questionnaires were returned. (The response rate was 78.6%.)
The questionnaires were used for data collection, and were divided into 5 sections: basic information of the respondent, perception on hospice and palliative care, notification of illness, acceptance of hospice care, and general concept of palliative care. The collected data were analyzed using a descriptive statistics test, one-way ANOVA, Pearson’s correlation, and a chi-square test by using SPSS Windows version 19.0.

Result
This study revealed that the more people learn regarding hospice care, the more they are willing to receive hospice care. (a) Approximately 92.6% of the respondents had heard of hospice and palliative care and approved of the physical, psychological, and spiritual care provided by hospice services. (b) Nearly 30.8% of those surveyed had never heard of the "Informed Consent Form for Hospice Care" and did not know when to sign a do-not-resuscitate (DNR) form. In addition, nearly 21.6% had never heard of the term “health care surrogate.” (c) Among those surveyed, approximately 44% believed that it is crucial to make an advanced medical directive when a person is conscious. However, nearly 17% had never considered signing an informed consent form for hospice care. (d) Furthermore, nearly 38% of the men and 46% of the women stated that they had no or scant exposure to hospice care-related advertising campaigns or that they did not know about the services provided by hospices.

Conclusion
Hopefully, the results of this study will be adopted as references by hospice policy providers and medical caregivers as they work toward hospice care promotion and advertising campaigns.

目錄
論文審定書 I
誌謝 II
中文摘要 III
ABSTRACT V
目錄 VII
第一章 緒論 1
第一節 研究背景及動機 1
第二節 研究目的 6
第二章 文獻查證 7
第一節「安寧療護」實踐全人醫療的理念 7
第二節 國內醫療單位對民眾所做的安寧緩和醫療調查 13
第三節 重要名詞解釋 14
第四節 尊重病人醫療自主權 17
第五節 安寧療護效益評估 23
第六節 選擇安寧療護費用分析 28
第三章 研究方法 28
第一節 研究假設 28
第二節 研究架構 29
第三節 研究對象及資料收集 30
第四節 研究假設 31
第五節 研究工具 33
第四章 研究分析與結果 39
第一節 描述性統計分析 39
第二節 問題假設與變項分析 48
第五章 討論與建議 58
第一節 研究結果 58
第二節 研究貢獻 60
第三節 研究分析 62
第四節 研究限制及建議 64
參考文獻 65
一、REFERENCES： 65
二、 中文部份： 68
附錄 72
一、安寧緩和醫療問卷調查 72
二、專家效度名單 78
三、安寧緩和醫療條例 79
四、安寧緩和醫療條例施行細則 81
五、安寧緩和醫療條例整理 82
六、安寧緩和醫療『四願書』 85
七、安寧療護民間團體 89
八、安寧緩和醫療條例修正案 90

一、References：
Ann Eve et al, Minimum dataset activity for hospice and hospital palliative care services in the UK 1997/98，Palliative Medicine 2000; 14: 395–404

Burns, C.M., Dixon, T., Broom, D., Smith, W.T., & Craft, P.S. (2003). Family caregiver knowledge of treatment intent in a longitudinal study of patients with advanced cancer. Supportive Care in Cancer, 11, 629-637.

Claire Henry, Pam Fenner , An introduction to the NHS End of Life Care Programme, End of Life Care, 2007, Vol 1, No 1.

Covinsky., KE., Eng, C., Lui, LY., Sands, LP., & Yaffre, K. (2003). The last 2 years of life: Functional trajectories of frail older people. Journal of the American Geriatric Society, 51, 492-498.

Economist Intelligence Unit LIEN foundation（2010）, The quality of death Ranking end-of-life care across the world,

EK Wilkinson et al, Patient and carer preference for, and satisfaction with, specialist models of palliative care: a systematic literature review. Palliative Medicine 1999; 13: 197–216

Fallowfield, LJ., Jenkins, VA., & Beveridge, HA. (2002). Truth may hurt deceit hurts more: Communication in palliative care. Palliative Medicine, 16:297-303.

Higginsion, IJ., & Costantini, M (2002). Communication in end-of-life cancer care : A comparison of team assessments in three European countries. Journal of clinical Oncology, 20,3674-3682.

Iwashyna, TJ., Ahang, Jx., & Christakis, NA. (2002). Disease-specific patterns of hospice and related healthcare use in an incidence cohort of seriously ill elderly patients. Journal of Palliative Medicine, 5, 531-538.

Jane Seymour, Sue Ryder Care Professor of Palliative and End of Life Studies, University of Nottingham, Changing times: preparing to meet palliative needs in the 21st Century, British Journal of Community Nursing Vol 16, No 01

Jean Potter et al, Symptoms in 400 patients referred to palliative care services: prevalence and patterns, Palliative Medicine 2003; 17: 310-314

Kaplowitz, SA., Campo, S., & Chiu, WT. (2002). Cancer patients’ desires for communication of prognosis information. Health communication, 14, 221-224.

Karen E. Steinhauser, PhD; Corrine I. Voils, PhD; Elizabeth C. Clipp, RN, MS, PhD;
Hayden B. Bosworth, PhD; Nicholas A. Christakis, MD, PhD, MPH; James A. Tulsky, MD, “Are You at Peace?” One Item to Probe Spiritual Concerns at the End of Life Archives of Internal Medicine/VOL 166, JAN 9, 2006

KELLI. STAJDUHAR, palliative Care at Home: Relections on HIV/AIDS Family Caregiving Experiences. Journal of palliative care 14:2/1998;14-22

Keith A. Thompson, Parag Bharadwaj, Kiran J. Philip and Ernst R. Schwarz, Heart failure therapy: beyond the guidelines, J Cardiovasc Med 11:919–927 Q 2010 Italian Federation of Cardiology.

Lunney, JR., Lynn, J., Foley, Dj, Lipson, S., & Guralnik, JM. (2003). Patterns of functional decline at the end of life. JAMA, 289, 2387-2392.

L. Grassi et al, Physicians’ attitudes to and problems with truth-telling to cancer patients, Support Care Cancer (2000) 8 :40–45

Margaret Stroebe et al, Bereavement research: methodological issues and ethical concerns, Palliative Medicine 2003; 17: 235 /240

Mari Lloyd-Williams et al, Which depression screening tools should be used in
palliative care? Palliative Medicine 2003; 17: 40 43

McCarthy, EP., Burns, RB., Ngo-Metzger, Q., Davis, RB., & Phillips, RS. (2003).
Hospice use among Medicare managed care and fee-for-service patients dying
with cancer. JAMA, 289, 2238-2245

NATHALIE STEINER, Équipe Mobile de Soins Palliatifs, Carouge, Switzerland, EDUARDO BRUERA, Palliative Care Program, Grey Nuns Community Hospital and Health Centre, Edmonton, Alberta, Canada ,Methods of Hydration in Palliative Care Patients, Journal of Palliative Care 14:2/1998

NCCN Clinical practice Guidelines in oncology (National comprehensive Cancer Network) Palliative Care version 2, 2011

NHS Lothian, Palliative Care Guidelines: Last days of life | Version 2 (2010)

Noritoshi Tanida, M.D. Professor and Chairman, Department of Medical Humanities, Yamaguchi University School of Medicine, Implications of Japanese religious views toward life and death in medicine.

Paker, Pa., Baile, WF., de Moor, C., Lenzi, R., Kudelka, AP., & Cohen, L. (2001). Breaking bad news about cancer: Patients’ preferences for communication. Journal of clinical Oncology, 19, 2049-2056.

Peter J Franks, Chris Salisbury, Nick Bosanquet, The level of need for palliative care: a systematic review of the literature. Palliative Medicine 2000; 14: 93–104

Rigndal, G.I., Joudhoy, M.S., & Kaasa, S. (2002). Family Satisfaction with end-of-life care for cancer patients in a cluster randomized trial. Journal of Pain and symptom Management, 24, 53-63.

Rod D. Grim, MA1, Diane McElwain, RN, OCN, MEd2, Rhada Hartmann, RN, BSN, CT3, Mary Hudak, MD3 and Sandra Young, MSN, RN, CVRN3 (2010), Evaluating Causes for Unplanned Hospital Readmissions of Palliative Care Patients, American Journal of Hospice & Palliative Medicine

Sarah J. Goodlin, MD; Gary S. Winzelberg, MD; Joan M. Teno, MD, MS;
Marie Whedon, RN, MS; Joanne Lynn, MD, MA, MS , Death in the Hospital, ARCH INTERN MED/VOL 158, JULY 27, 1998

Steele, L. L., Mills, B., Long, M.R., & Hagopian, GA. (2002). Patient and caregiver satisfaction with end-of-life care: Does high satisfaction mean high quality of care? American Journal of Hospice & Palliative care, 19, 19-27.

Tranmer, JE., Heyland, D., Dudgeon, D., Groll, D., Squireds-Graham, M., & Couslon, K. (2003). Measuring the Symptom Experience of Seriously III Cancer and Non-cancer Hospitalized Patients Near the End of Life with the Memorial symptom Assessment Scale. Journal of pain and symptom Management, 25, 420-429.

Viser, A., van Leeuwen, AF., Voogt, E., van der Heide, A., & van der Rijt, K (2003). Clinical decision-making at the end of life: The role of the patients’s wish. Patient Education and Counseling, 50,263-264.

二、中文部份：

王翠蘭護理師，一位舌癌併發直腸癌，末期病人之護理經驗，志為護理第七卷第一期127。

白玉珠(民82)。在職進修學士學位護理人員工作滿意度及其相關因素之研究。國醫學院護理學研究所碩士論文。

石芬芬(民84)。藥癮戒治病房護理人員的工作壓力與因應行為之探討。國立台灣
大學。

米奇.艾爾邦Mitch Albom著(1998)。最後14堂星期二的課。台北：大塊文化。

石世明著(2009)。伴你最後一程 ---臨終關懷的愛與慈悲。台北：天下文化書坊。

石世明(2001,08)，伴你最後一程，天下文化出版。

安寧照顧會訊。台北：台灣安寧照顧基金會，80。

安寧緩和醫療條例---作業臨床手冊，財團法人中華民國安寧照顧基金會。

全民健康保險雙月刊 96期27。

行政院衛生署新聞稿，99年國人主要死因統計(以ICD-10編碼)，99年國人標準化死亡率下降；國人平均壽命持續增長。

老人心理治療(心理出版社)，第八章生命回顧在老人心理治療的運用。

李美華、孔祥明等合譯(2004.7)。(The Practice of Social Research)�社會科學研究方法(上、下)。台北：時英出版社。
沈錳碩醫師，安寧療護的歷史、現況與未來ppt。壢新醫院家庭醫學科。

黃志芳醫師，安寧療護簡介ppt，高雄長庚醫院。

姚建安醫師，末期病人臨床決策倫理與困境ppt，台大醫院緩和醫療病房。

何京鰲、王復明、杜明勳等，癌症病人之神經病變性疼痛，高雄榮民總醫院家庭
醫學科林明慧醫師(1998)， 癌末病患臨終期之安寧照護,台北榮總家庭醫學部。

林明慧醫師，安寧療護臨床決策之醫學倫理， 台北榮總家庭醫學部。

林明慧醫師(2000)，症狀控制與護理 –呼吸道問題及實務處理經驗，台北榮總家庭醫學部。

林清華等，焦慮症之藥物治療（Pharmacotherapy of Anxiety Disorders）。

林鵬展，末期疼痛及症狀的評估與處理，成大醫院。

邱智鈴護理長，Ｍanagement of Fungating wound in hospice Palliative Care,
成大醫院緣恩病房。

陳聲平、呂昭林，壓力相關之精神官能症，國軍松山醫院。

張正雄副院長，如何告知負面訊息（Breaking Bed News），財團法人彰化基督教醫院。

張明志著(2008)。安寧的藝術。台北：天下雜誌股份有限公司。

張志明醫師，醫師協助死亡（Physician-assisted Suicide），台北馬偕醫院血液腫瘤科。

張嫣紅(2003)，安寧病房護理人員工作壓力、因應策略與工作滿意度之相關研究，南華大學生死學研究所碩士論文。

黃勝堅(2012,04)，急重症生命末期照護及緩解性手術介入介紹，奇美醫院。

黃勝堅(2010),生死謎藏：善終，和大家想的不一樣，大塊文化出版社。

黃勝堅(2011)，夕陽山外山(生死謎藏2)，大塊文化出版社。

韋至信(民92)，醫生也醫死。台北：文經文庫。

趙可式等(2012)，不予及撒除/終止維生醫療指引，安寧緩和護理學會

趙可式著（2011），安寧伴行。台北：天下遠見出版股份有限公司。

趙可式著（1995），康泰安寧療護手冊。台北：財團法人天主教康泰醫療教育基金會。
蘇文浩醫師，生命態度與安寧療護認知，台灣安寧照顧基金會電子報2012 。

蘇文浩(2012)，為什麼醫療人員需要認識「預立醫療自主計劃」？安寧照顧基金會安寧講堂。

賈淑麗，居家照護機構設立，為輔仁大學護理系副教授。

漢克.鄧恩（2009），愛的抉擇---如何陪伴療護與尊重放手Hard choices for loving people by Hank Dunn。台北：城邦讀書花園。