| Summary: | 碩士 === 國立臺灣大學 === 公共衛生碩士學位學程 === 105 === Background:
According to the statistic from Ministry of Health and Welfare, on the basis of the order of death rate, cancer has been the top factor to cause death. in the nearing death stage, it belongs the high-cost health care, while hospice and palliative care has approach effects on saving cost. However, the rate on using hospice and palliative care for cancer patients is lower than those in other countries and most of patients choose to go to medical center. Nevertheless, early-aged hospice and palliative care can decrease the unnecessary service on treatment and medical care. Therefore, deep understanding hospice and palliative care and health-need resource for end-of-life patients is in urgent.
Object:
To understand the diversity of health-need for end-of-life patients, this thesis can be the reference for the related development of Health and Welfare project.
Method:
The method in this thesis is qualitative research. The researcher uses hermeneutic phenomenology as research way. For the interview resource, the researcher applies the process of analysing qualitative resource, proposed by Huberman and Miles (1994), and on the basis of four needs, submitted by Bradshow (1972) to conduct need assessment; furthermore, the researcher uses data analysis to collect the data between presented needs and comparative needs. Last, the researcher applies deep interview method to gather data between expert needs and felt needs. The day of collecting data is from January to July, 2017. The research objects are two patients, main caregivers, doctors, and five registered nurses. There are totally eleven objects.
Result:
In the founding of felt and expert needs, in physical facet, the end-of-life patients have “symtom control” needs, in mental facet, they have “mental accommodation” needs, in social facet, they have “family support and company,” “the interaction with other cancer patients,” “immediately professional medical information,” “respite care service,” etc. In the presented facet, up to July 14th, 2017, there are already sixty-six hospitals which provide hospice and palliative care service, one hundred and four family medical centers have provided palliative medicine in the home service, one hundred and forty seven hospitals have provided hospice palliative shared care service, and two hundred and thirty seven hospitals have provided community hospice palliative care service. According to the statistic in the caculation of dead body by National Health Insurance Administration, and Ministry of Health and Welfare, from 2011 to 2014. It can be summarized as follows, 45.2% in 2011, 63.1% in 2012, 73.4% in 2013, and 82.1% in 2014. The result shows that the percentage number has been raised year by year, and the average declining rate is 29%. On the basis of decling rate, the researcher estimates that the care rate after 2015 will get much higher, and the limited rate is 100%. In the comparative needs facet, it shows that in end-of-life patients’ health needs, there are some different points of view in patients, main caregivers, and experts; furthermore, there are a few end-of-life patients’ health needs are not satisfied.
Conclusion:
It is a wide range in end-of-life patients’ health needs, and there are a few health needs which has not been satisfied. For the related government policy plan in the future, we should attach importance to these health needs and accept opinions from different aspects.
Keywords: End-of-life, hospice palliative care, health needs, needs assessment,mental health
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