展望更好的善終-醫務社會工作師推動預立醫療照護諮商之經驗

Abstract

本研究透過深度訪談法進行資料蒐集，研究參與者為九位現職為醫學中心或區域醫院且具備提供Pre-ACP與ACP諮商經驗一年以上（含）之醫務社工師，以探究醫務社工師推動預立醫療照護諮商之經驗，其中包含ACP的運作模式、醫務社工師在ACP的角色與知能、推動ACP的挑戰與因應策略以及推動ACP的社會文化困境。本研究的研究結果為：壹、諮商團隊多由既有的安寧團隊組成，較具諮商執行之優勢。 貳、ACP各階段有其運作流程與目標任務。 參、民眾在ACP各階段關注的問題有所不同，包含法律、諮商規範以及醫療照護層面之議題。 肆、醫務社工師在ACP各階段扮演多元且重要的角色。 伍、醫務社工師參與Pre-ACP有利於社會工作專業角色展現。 陸、推動ACP面臨制度、實務、教育層面的問題與挑戰。 柒、避談生死議題及重視家庭主義與關係脈絡的社會文化對推動ACP之束縛。

本研究針對研究結果進行探討，並就制度層面、實務層面、教育層面提出相關的因應策略，以及促使《病人自主權利法》更加完備之建議，以提供未來醫務社工師在推動與執行ACP作為參考。

This study conducted the in-depth interview. The interviewees are nine medical social workers who possess more than one year（inclusive）experience in providing Pre-ACP and ACP consultation and work at medical centers or regional hospitals currently. The purpose is to explore the experience of medical social workers being responsible for promoting Advance Care Planning, including ACP operation model, the knowledge of ACP, the roles they act as in promoting process, challenges and strategies they might face, and social and cultural difficulties in promoting ACP. The results of this study were found that:1. The consulting team is mainly composed of the existing hospice team, which has the advantage of consulting execution. 2. Each stage of ACP has its own operation process and target task. 3. The people concentrate on different issues at each stage of the ACP, including law, consultation norms, and medical care. 4. Medical social workers play diverse and important roles in all stages of ACP. 5. The participation of medical social workers in Pre-ACP is conducive to the display of the professional role of social work.6. Promoting ACP has faced problems and challenges at the system, practice, and education.7. Avoid talking about life and death issues, placing importance on familyism and relationship context might be the constraints of promoting ACP.In the view of the results, this study discusses and proposes relevant response strategies on the system, practice, education, and suggestions for making the "Patient Autonomy Act" more complete, so as to provide references for promoting and implementing ACP.