進入臨床前的醫學生對預立醫囑的經驗、認知、態度及教育需求之探討

Abstract

隨著社會人口的老化及醫療的進步，生命末期的照護方式漸漸受到重視，而「預立醫囑」成為一個重要的依據。 本研究想了解即將進入臨床的醫學生對於預立醫囑的經驗、認知、態度與教育需求的現況。採自擬問卷調查，立意取樣四所公私立大學之醫學系四年級、五年級學生500位。得有效問卷354份。以卡方檢定、t 檢定、費氏正確檢定、變異數分析、皮爾森積差相關進行資料統計分析。結果發現: 一、 預立醫囑認知與系級有顯著相關(五年級分數高於四年級)。 二、 預立醫囑的態度與認知沒有顯著相關，但預立醫囑態度與教育需求有顯著正相關。 三、 七成以上學生願意推廣及預立醫囑。 四、 醫學生認為預立醫囑是生命重要的議題且認為自己決定生命末期治療方向很重要，但因為討論死亡在台灣文化中是禁忌，且不熟練與病人、家屬溝通解釋病情成為推廣上的障礙。 五、 課程上希望加強維生器的撤除時機、預立醫囑介入時機、病情告知等技巧。學生肯定預立醫囑教育的需求，多數認為應列入必修及實習課程。 最後針對本研究結果提出建議，以作為後續預立醫囑推廣及規劃醫學教育課程與研究之參考

As the coming of aged society and the improvement of medicine, the care of terminal patient become a big issue as well as advance directives. Our research is using a structured questionnaire to investigate the experience, acknowledge, attitudes and demand of education toward advance directives among pre-clinical medical students. The effective samples were 354. The data were analyzed by t-test, Chi-Square test, Fisher’s Exact test, Anova test and Pearson product-moment correlation. The major findings of the study were as follows: 1. The acknowledge of advance directives was significantly difference on grade. 2. Ther is no significant relationship between attitude and acknowledge of advance directives, but attitudes and demand of education correlated positively. 3. More than 70% students would like to promote and do advance directives 4. Students view advance directives as an important life issue and also think it is important to make advance care planning by self. However to discuss death is an prohibition in Taiwan culture, also without enough confidence to discuss disease prognosis with patient and their family may discourage students. 5. The time to remove life-survive machine, the time to discuss advance directives, the skill of trueth-telling of illness are the most 3 point that studens want to know. Students have positive attitude toward educational demand and think advance directives teaching should be a must-learn class and including in internship.

Based on the finding of the study, recommendations which was suggestions for future study and demand of education intervention were drawn