1. 回應 臺大醫院家庭醫學部 程劭儀 MD, MSc, DrPH candidate

2. Biological aspect Free of physical sufferings such as pain, dyspnea Psychological aspect 1. Anxiety 2. Depression Quality of life of terminal cancer patients Social aspect 1. Family support Existential/spiritual aspect 1. Meaningful 2. Autonomy Good death of terminal cancer patients Nature of health care Quality of care Life closure and death preparation Circumstances of death Demographics Age Sex Origin of cancer

3. Trends in quality of end-of-life care for Taiwanese cancer patients who died in 2000-2006 Ann Oncol. 2009 Feb;20(2):343-8. In the last month of life, cancer care tended to become increasingly aggressive as shown by (i) intensive use of chemotherapy (15.45%-17.28%), (ii) frequent emergency room visits (15.69%-20.99%) and >14-day hospital stays (41.48%-46.20%), (iii) admissions to intensive care units (10.04%-12.41%), (iv) hospital deaths (59.11%-65.40%). Use of cardiopulmonary resuscitation (13.09%-8.41%), intubation (26.01%-21.07%), and mechanical ventilation (27.46%-27.05%) decreased, whereas use of hospice services increased considerably (7.34%-16.83%).

4. 社區安寧緩和醫療 結合社區醫療群 安寧視訊

5. 社區的醫師、護士準備好了嗎？ 提供安寧緩和醫療的意願醫師 (N=410) 百分比 ( 人 ) 護士 (N=927) 百分比 ( 人 ) 不願意或無意見 7.6 (31) 7.0 (65) 願意 92.4 (379)93.0 (862) 提供諮詢 83.4 (342)91.5 (788) 提供轉介 86.8 (356)87.2 (751) 看病或開立處方 62.0 (254) 提供居家訪視 42.2 (173)51.0 (439) 提供電訪 45.6 (187)61.9 (533) 提供家屬哀傷輔導 35.1 (144)38.4 (331) Chiu et al: Establishment and evaluation of a scheme for facilitating community physicians to provide palliative care in Taiwan. 2007. Hu et al: Nurses’ willingness to provide palliative care. J Pain Sympt Manage. 2003.

6. Advantages of home telehealth Convenient Accessible Cost-saving

7. Problems encountered Construction of IT Economic burden from family Duration of plan.

8. 期許 於政策面著手，正視社區安寧療護的需求， 使末期病人能夠 “ 放心回家 ”!

9. Thank you.