碩士 / 中山醫學大學 / 醫學研究所 / 90 / Qualifying care of end of life is a trend in the developed country. There are about 130 thousands death, during 2001 DC in Taiwan, cancer is the leading cause to account for 26% of total death. End of life care has become a popular subject following the “ Hospice ordinance of Taiwan ” into practice. However, the definition of “a good death”, which is the highest aim of a hospice palliative team, is still obscure.
The purpose of this article is to explore all domains of quality of life (QL) of the terminal ill cancer patients. With an eye on the last period of life, the impact of events around death against health will be profiled. This study tries to address the regional definitions and scope of these terminal events and suppose that the end point of “ a good death ” must be an attitude of positive well-being. In this point of view, we hope to construct a regional QL instrument for end of life care. This instrument can be used for a standard of clinical evaluation and outcome audit. The implications of this study include as the following: the framework and principles of a good death; the discussion of clinical evaluation and outcome audit in hospice palliative care; themes of death; the techniques of assessing the other important domains than physical symptoms, especially the psychosocial and spiritual domains, in end of life care; the analysis of factors affecting the quality of life of terminal ill cancer patients. Reviewing current theories of QL study, process of constructing a QL index was conducted as well as guideline of QL report.
In this study, a frame of a good death was sketched and the “Good Death Index” was schemed with 3 domains; 18 items and 5 additional notations, by the way of detailed articles review and hermeneutic circle. A format of “Good Death Scale” was administrated clinically. For practical use and validation, a “problem-orientated questionnaire for caregiver” was designed with operational definitions and examples as an interface and a “ wishes and concerns questionnaire for patient” for conceptual study and criterion.
After a basic validation practiced in our Hospice Palliative care unit with collecting 144 questionnaires, “Good Death Scale” showed a fair validity and reliability in Criterion-related validity（Spearman rank correlation 0.142-0.874, almost among 0.5-0.8, P<0.01）；content validity；construct validity；inter-rater reliability（Spearman rank correlation 0.065-0.95, almost among 0.5-0.8, P<0.01）and item discrimination analysis（critical ratio 2.31-5.33）.
In the last chapter, content revision and a new version of Good Death index were brought up, as well as further study under the new framework. In addition, models of QL report and end of life care were discussed. These experiences from this study may be useful for regional analogous study in Taiwan.
| Identifer | oai:union.ndltd.org:TW/090CSMU0534013 |
| Date | January 2002 |
| Creators | Chiu Yung-Wei, 邱永偉 |
| Contributors | Chou Hsi-Hsien, 周希諴 |
| Source Sets | National Digital Library of Theses and Dissertations in Taiwan |
| Language | zh-TW |
| Detected Language | English |
| Type | 學位論文 ; thesis |
| Format | 141 |
Page generated in 0.013 seconds