背景：2020年3月爆發的COVID-19大流行對癌症護理造成了顯著的干擾，並加劇了末期疾病的進展。此外，疫情的心理影響可能會顯著影響對生命末期護理的看法。本研究旨在評估COVID-19疫情的嚴重程度對住院末期癌症患者在臺灣安寧緩和醫療（HPC）登記的影響。
方法：本研究收集了2017年1月至2023年2月期間在高雄榮民總醫院死亡的癌症患者資料。具有不再施行心肺復甦術（DNR）指示的患者被認為具有醫師確認的末期病狀。據世界衛生組織定義的新冠疫情流行時間以及臺灣臺灣衛生福利部的報告，疫情分為兩個階段：第一階段（2020年3月1日－2021年3月31日）：疫情初期，確診病例較少；第二階段（2021年4月1日－2023年2月28日）：由Delta和Omicron變異株引發的社區群聚期間。使用STATA 14.0進行卡方檢定、t檢定、一元ANOVA和羅吉斯迴歸等統計分析，p值<0.05被視為統計上顯著。
結果：在3999名具有DNR指示的癌症患者中，79.47%接受了HPC。疫情期間HPC登記率顯著增加（疫情前76.78% vs. 疫情期間82.54%，p<0.001）。二元羅吉斯迴歸分析顯示，COVID-19的兩個階段以及臨終出院與HPC登記呈正相關。相比之下，男性和住進加護病房的患者與HPC登記呈負相關。
結論：COVID-19大流行對末期癌症患者的安寧緩和醫療接受情形產生了顯著影響。這些發現強調了在公共衛生危機期間，將疫情相關因素納入醫療規劃和資源分配的重要性，以確保在公共衛生危機期間，所有有需求的患者都能獲得安寧緩和醫療服務。

Introduction：The COVID-19 pandemic outbreak in Mar 2020 has disrupted cancer care and exacerbated the progression of terminal illnesses worldwide. Additionally, the pandemic's psychological impact may significantly influence perceptions of end-of-life care. This study aims to evaluate the effect of COVID-19 severity on the hospice palliative care enrollment of hospitalized terminal cancer patients in Taiwan.
Methods：Data were collected on deceased cancer patients at Kaohsiung Veterans General Hospital between January 2017 and February 2023. Patients with Do-Not-Resuscitate orders were considered to have physician-identified terminal status. According to the World Health Organization's definition of the COVID-19 pandemic period and the report from Taiwan's Ministry of Health and Welfare, the pandemic is divided into two phases: Phase 1 (March 1, 2020 – March 31, 2021): the early stage with few confirmed cases; Phase 2 (April 1, 2021 – February 28, 2023): the period of community clusters caused by Delta and Omicron variants. Statistical analyses, including chi-square tests, t-tests, one-way ANOVA, and logistic regression, were conducted using STATA 14.0. A p-value < 0.05 was considered statistically significant.
Results：Among 3,999 cancer patients with DNR orders, 79.47% received HPC. The HPC enrollment rate significantly increased during the pandemic (76.78% pre-pandemic vs. 82.54% during the pandemic, p < 0.001). Binary logistic regression indicated a positive association of HPC enrollment with both phases of COVID-19 and impending death discharge. In contrast, it showed a negative association with male gender and admission to the intensive care unit.
Conclusion：The COVID-19 pandemic significantly impacted the utilization of palliative care among terminal cancer patients. These findings highlight the importance of incorporating pandemic-related factors into healthcare planning and resource allocation to ensure that all needy patients can access palliative care during public health crises.

論文審定書 i
誌謝 ii
中文摘要 iii
英文摘要 iv
第一章緒論 1
第一節研究背景與動機 3
第二節研究問題與研究目的 10
第二章文獻探討 12
第一節安寧緩和醫療的演變 12
第二節臺灣安寧緩和醫療的發展 15
第三節新冠疫情 20
第四節變項間的關係 24
第五節醫療名詞解釋 26
第六節文獻探討小節 28
第三章研究方法 29
第一節研究設計與研究架構 29
第二節研究對象與資料來源 30
第三節研究假設 33
第四節研究變項與操作型定義 34
第五節資料處理 與分析方法 36
第四章資料分析結果 38
第一節 研究個案基本特性 38
第二節 連續變項比較分析結果 43
第三節 類別變項比較分析結果 49
第四節羅吉斯迴歸分析 62
第五節負二項式迴歸分析結果 67
第五章討論與建議 69
第一節 研究假設驗證 69
第二節 研究討論 72
第三節 實務意涵 77
第四節 研究限制 79
第五節 後續研究建議 81
參考文獻 83
附錄 90

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