本研究旨在探討不同人格特質的醫師與Against-advise discharge (AAD)發生的關聯性，進而了解不同人格特質的醫師，對於AAD病患的態度與行為是否有所差異。本研究採取「計畫行為理論」，透過「行為態度」、「主觀規範」、「知覺行為控制」、「行為意圖」、「實際行為」等面向，並利用過去國內外相關文獻之研究成果擬定為本研究之問卷題項，以作為衡量的工具。
研究結果發現，高達92.2%醫師曾經有過開立違背醫囑自動出院之經驗，其態度、主觀規範、知覺行為控制問項平均得分為6.036、5.276、5.818，以七分法量測之，顯示醫師對於違背醫囑自動出院較為正向之看法。經迴歸分析後，醫師於知覺行為控制構面、行為意圖，與醫師對AAD病患的醫療行為具有顯著影響，其中以知覺行為控制和行為意圖之β值分別為（0.45***、0.43***）達顯著水準，表示知覺行為控制和行為意圖，可以正向預測醫師對AAD病患的醫療行為。
依據研究結果建議，知覺行為控制，乃表示個體對於資源及機會掌握的多寡，將會影響後續行為的改變。因此本研究分析結果中，又以知覺行為控制，影響行為最為顯著，故研究建議可針對較頻繁發生違背醫囑自動出院之單位，如急診、內外科等，提供相對應的資源以及策略參考，協助各個單位擬訂SOP，讓醫師在面對AAD患者時，能夠掌握更多的知識與資源來應對，如此可以減少醫師面對AAD病患時的壓力，亦能夠提升AAD病患的照護品質。

Objectives: The aim of this study is to explore doctors' attitudes and behavior toward patients' against-advise discharge (AAD) and put forward the countermeasures to improve the medical quality of AAD patients, to reduce the risk and waste of resources caused by AAD.
Methods: For facilitating medical providers to deal effectively with those patients and promote quality of care, this study's questionnaire was designed according to the Theory of Planed Behavior (TPB) model. The questionnaire including (1) doctors' demographics, (2) Big Five personality traits, (3) TPB model five structures. The answer to the survey is based on the seven-point Likert-type scale. The questionnaire design is based on related literature and discussion with experts.
Results: The results showed that 92.2% of the doctors had the experience of being discharged automatically against medical advice. The average scores of attitude, subjective norm and perceived behavior control were 6.036, 5.276 and 5.818, respectively, which were measured on a 7-point scale. It shows that doctors hold a positive attitude towards automatic discharge against medical advice. Through regression analysis, doctors' perceived behavioral control dimension and behavioral intention were significantly correlated with doctors' medical behavior toward AAD patients. The β value of perceptual behavioral control and behavioral intention is (0.45***, 0.43***), which indicates that perceptual behavioral control and behavioral intention are significant. It can positively predict the physician's medical behavior in patients with AAD.
Conclusions: Research shows that perceived behavioral control represents the number of resources and opportunities available to individuals and will influence subsequent behavioral changes. Therefore, in the analysis results of this study, perceptual behavioral control has the most significant influence on behavior. Therefore, research suggests that for more frequent automatic discharge against medical advice unit, such as emergency department, internal medicine, surgical provide the corresponding reference resources and strategy, to assist the various units to formulate the SOP, let physicians, in the face of the patients with AAD can master more knowledge and resources to deal with, so can reduce the pressure when patients were facing AAD, it can also improve the quality of care for patients with AAD.

論文審定書...........................................................................................i
致謝...................................................................................................... ii
論文摘要.............................................................................................. iii Abstract.................................................................................................iv
目錄.......................................................................................................vi
圖次...................................................................................................... viii
表次.......................................................................................................ix
第壹章 緒論..........................................................................................1
第一節 研究背景與動機......................................................................1
第二節 研究目的..................................................................................3
第三節 研究流程..................................................................................4
第貳章 文獻探討..................................................................................6
第一節 計畫行為理論..........................................................................6
第二節 人格特質..................................................................................12
第三節 違背醫囑自動出院..................................................................17
第四節 重要文獻整理..........................................................................20
第五節 文獻探討小結..........................................................................24
第參章 研究方法..................................................................................25
第一節 研究架構與假說......................................................................25
第二節 研究對象與收案方式..............................................................26
第三節 操作性定義與問卷設計..........................................................28
第四節 問卷信效度分析......................................................................34
第五節 資料處理與分析方法..............................................................40
第肆章 研究結果..................................................................................42
第一節 描述性統計分析......................................................................42
第二節 t 檢定與單因子變異數分析 ...................................................54
第三節 皮爾森積差相關分析..............................................................58
第四節 二元羅吉斯迴歸分析..............................................................59
第五節 線性迴歸分析..........................................................................60
第六節 研究假說檢定結果..................................................................66
第伍章 討論與建議..............................................................................68
第一節 討論..........................................................................................68
第二節 研究限制與未來研究建議......................................................73
第三節 研究貢獻..................................................................................74
參考文獻...............................................................................................75
附錄.......................................................................................................81 一、 人體試驗委員會核准同意函......................................................81 二、 專家效度問卷..............................................................................83 三、 專家效度審查意見整理..............................................................89 四、 正式問卷......................................................................................90

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