An analysis of decision-making for long-term ventilator dependent patients, families and medical professionals

• Main Authors: Chin Lien Chiu, 邱金蓮
• Other Authors: Y. P. Wen
• Format: Others
• Published: 2012
• Online Access: http://ndltd.ncl.edu.tw/handle/36870309633620598118

碩士 === 長庚大學 === 管理學院碩士學位學程在職專班醫務管理組 === 100 === Medical technology progress in recent years has prolonged life expectancy for critically ill patients. Mechanical ventilation-dependent patients have become a significant group in today’s medical society. The Taiwan National Health Insurance Bureau implemented the Integrated Delivery System (IDS) starting July, 2000 to cover mechanical ventilation expenditures occurred in four stages: intensive care unit（ICU）, respiratory care center (RCC), respiratory care ward, and home care. Caring for mechanical ventilation-dependent patients requires unique medical knowledge and skills, thus transfers into higher expenditures than usual, making it difficult to choose facilities to care for patients. Most of medical decisions are shared decision made by family members after discussing with medical staff. On the other hand, the attitude and perception of medical staff also could be affected by family. However, studies tend to focus on the utilization and weaning of mechanical ventilation, or care-givers’ demand and quality of life. The issues of whether the expectations, perception, and concerns of family members and medical staff differ are seldom investigated, whereas such differences could affected the quality of communication and medical-decisions. Therefore, this study aims to examine whether and to what extent family members and medical staff differ in the above issues and discuss policy implications. This study uses questionnaires and purposive sampling at 5 sites in Taipei/New Taipei cities. Medical staff sample includes physicians, respiratory therapists, nurses and social workers.(n=178). Patient sample includes visiting family members (n=91). Main questions cover topics on perceptions about mechanical-ventilation survival, concerns about choosing facilities, and experiences on family-medical staff communication. Data are analyzed with ANOVA. Results indicate that: (1) Family’s perception about perception about patient survival (66%) is significantly higher than that of the medical staff’s (55%). (2) When it comes to choose a way to care the patients, family members’ most and foremost concern is the care-givers’ ability, whereas medical staff put patients’ prognosis as the top concern. (3) Family members’ experience on communication with medical staff are generally satisfactory and consistent with medical staff’s perception. In conclusion, the results show that while mechanical ventilation-dependent patient family members have somewhat satisfactory experiences communicating with medical staff, there is room for improvement for future shared decision-making.