Fan Shu-Yi, Kao Chi-Yin
MSN, RN, Research Assistant, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan, ROC.
PhD, RN, Associate Professor, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan, ROC.
Hu Li Za Zhi. 2024 Oct;71(5):36-45. doi: 10.6224/JN.202410_71(5).06.
After enactment of the Patient Right to Autonomy Act in Taiwan, most of the individuals participating in advance care planning (ACP) and signing advance decisions (AD) have been healthy adults. This demographic is inadequately covered in the literature, in which related studies focus primarily on individuals with major illnesses.
This study was implemented to understand the experiences of healthy adults participating in ACP.
A qualitative approach was taken and participants were recruited from ACP outpatient clinics in three hospitals in northern, central, and southern Taiwan. All of the participants were healthy adults who had completed the ACP process, did not have a major illness, had no psychiatric diagnoses, and could express themselves clearly. Data were collected via semi-structured interviews and analyzed using content analysis.
A total of 15 participants were interviewed, generating three major themes: "Establishing the foundations of ACP", "Preserving dignity in end-of-life care", and "Key elements for successful ACP". Their motivation to engage in ACP and sign the AD form was influenced by past experiences and a desire to maintain dignity and physical autonomy through the aging process. Their decision-making processes were influenced by family opinions, sociocultural factors, and systemic dynamics.
CONCLUSIONS / IMPLICATIONS FOR PRACTICE: During the ACP and AD signing process, the consulting team not only helps healthy adults successfully provide informed consent but also, by fostering a supportive communication environment, ensures medical preferences and expectations are accurately reflected, thus promoting mutual care, support, and understanding among all parties.
台湾《病人自主权利法》颁布后,参与预立医疗照护计划(ACP)并签署预立决定(AD)的大多是健康成年人。这一人群在文献中未得到充分涵盖,相关研究主要聚焦于患有重大疾病的个体。
本研究旨在了解健康成年人参与预立医疗照护计划的经历。
采用质性研究方法,从台湾北部、中部和南部三家医院的预立医疗照护计划门诊招募参与者。所有参与者均为完成预立医疗照护计划流程的健康成年人,没有重大疾病,无精神疾病诊断,且能够清晰表达自己。通过半结构式访谈收集数据,并采用内容分析法进行分析。
共访谈了15名参与者,产生了三个主要主题:“奠定预立医疗照护计划的基础”、“在临终关怀中维护尊严”以及“预立医疗照护计划成功的关键要素”。他们参与预立医疗照护计划并签署预立决定表格的动机受到过往经历以及在衰老过程中维护尊严和身体自主权愿望的影响。他们的决策过程受到家庭意见、社会文化因素和系统动态的影响。
结论/对实践的启示:在预立医疗照护计划和签署预立决定的过程中,咨询团队不仅要帮助健康成年人成功提供知情同意,还要通过营造支持性的沟通环境,确保准确反映医疗偏好和期望,从而促进各方之间的相互关怀、支持和理解。