樂齡醫療志工的生命意義與其簽署預立醫療指示意願之相關性

Abstract

研究目的：因預立醫療指示相關研究，向來是對簽署意願與否的倚重，乃至於「意義治療」理論的心理層面內涵及狀態卻未臻完善。因此，本研究欲探討「樂齡醫療志工生命意義」與「個體預立醫療指示」的醫療自主決策之關係。 研究方法：本研究係以橫斷式研究設計、透過立意取樣調查北區某醫學中心55歲（含）以上樂齡醫療志工244位。結構式問卷涵蓋「研究對象特質調查表」、「生命意義量表」、「預立醫療指示意願」三部份，運用SPSS22.0版進行統計分析，採用多變項羅吉斯迴歸探討簽署預立醫療指示意願之相關因子。 研究結果：研究對象擁有高度生命意義感（平均分數為4.04分，標準差＝0.45），有61.89％簽署預立醫療指示。而女性（勝算比＝2.350，95％信賴區間：1.201-4.598）、年齡（年）（勝算比＝1.071，95％信賴區間：1.016-1.129）、曾參與放棄親人急救同意書討論（勝算比＝0.317，95％信賴區間：0.175-0.574）、生命意義之「死亡接納」構面（勝算比＝1.107，95％信賴區間：1.025-1.195）均與樂齡醫療志工簽署預立醫療指示意願有顯著相關，總解釋變異量達20.8％。 結論：本研究結果可以提供樂齡醫療志工的相關人員對其生命意義的內在價值瞭解，並且透過「『曾參與放棄親人急救同意書討論』經驗」與生命意義「死亡接納」，加強生命教育以及「癌症服務類志工」人才培育之共同合作的措施，進而能給予樂齡者對醫療意願回歸「主體」之認知與自主抉擇。Purpose: This study aimed to examine the association between meaning of life and the signature of advance directive among senior medical volunteers. Methods: Two hundred and forty-four senior volunteers in a medical central hospital in Northern Taiwan were recruited in this cross-sectional study. The questionnaire includes personal characteristics, meaning of life, and the signiture of advance directive. Data were analyzed by using SPSS 22.0. Results: The surveyed senior medical volunteers reported a high level of meaning of life, and 61.89% has signed their advance directive. The multivariate logistic regression model shows that female (OR＝2.350，95％CI＝1.201-4.598), age (OR＝1.071，95％CI＝1.016-1.129), experience of discussing Do Not Resuscitate (OR＝0.317，95％CI＝0.175-0.574), acceptability of death(OR＝1.107，95％CI＝.1.025-1.195) were significantly associated with the odds of signing advance directive in this population. Conclusion: Fingings of the study may help promote advance directive through offering people more information to think about meaning of life.