台灣醫學生對於安寧緩和醫學態度之研究

緣由及目的：由於台灣每年有四萬名癌症末期病患死亡，所以安寧療護更顯其重要性。本研究以瞭解醫學生對安寧療護的態度，做未來醫學教育課程之參考。研究設計：以全國十二所醫學院的醫學生以自填式問卷做橫斷面調查研究。問卷分三部分，第一是安寧療護的認知。第二是安寧療護的態度。第三是受測者之基本資料。結果：東部醫學生有實際參與安寧療護志工工作，以及從學校教育管道得知安寧緩和醫療者較多，但贊成將生死學列入國民教育正式課程中者反而較少，中部醫學生對將安寧療護列為選修學科贊成較少。二年級醫學生較願意參與志工行列。女性醫學生願意參與志工工作者較多。具佛教信仰的醫學生認為全民健保應該給付安寧療護，以及願意參與安寧療護志工工作，在未來有意願從事安寧療護工作等都居多。有修過醫學倫理相關課程的醫學生較多反對把「安寧療護」合併在醫學倫理課程中，較不反對將「安寧療護」列為選修學科。曾擔任過醫院志工的醫學生較不願意參與安寧療護志工工作；家人有癌症病患的醫學生將來有願意從事安寧療護工作者較少。結論：台灣醫學生的安寧療護教育課程仍然不足夠，提供兼具知識與實習經驗之安寧療護教育課程，以培養未來醫師對於安寧療護的能力，將是我們當前必須努力的目標。
BACKGROUND AND OBJECTIVES: Care programs targeting the needs of the terminally ill are gaining in importance in Taiwan. In terms of cancer alone, Taiwan has over 40,000 deaths each year. Knowledge and competence related to hospice palliative medicine, however, remains inadequate among Taiwan clinical physicians. The present study was conducted in support of the development of a formal hospice palliative care curriculum for medical students. METHODS: Medical students from twelve Taiwan medical colleges were invited to participate in this survey. Self-administered questionnaires were designed that asked questions in three “domains”: the first assessed students’ basic knowledge regarding hospice care; the second assessed student attitudes toward hospice care; the third acquired background data on the survey participant. RESULTS: Students from Taiwan’s East Coast returned a higher rate of disapproval toward making palliative and end-of-life care part of students’ compulsory education. Students at schools in central Taiwan showed stronger disapproval for making palliative and end-of-life care an elective subject. Junior (second year) and female students, as well as those claiming their religion as “Buddhist”, indicated a relatively stronger approval in their answer to the questing whether they would support payment for hospice care from the National Health Insurance plan. Buddhist respondents also indicated greater relative willingness to become hospice care physicians. Students who had already completed their curriculum in medical ethics indicated relatively stronger disapproval of including hospice-palliative training in the ethics curriculum, although relatively more approved of developing such as an optional course. Medical students with previous hospital volunteer experience did not indicate greater willingness to serve as a hospice volunteer. Those from families with terminally ill relative experience did not show a greater willingness to become hospice care physicians. CONCLUSION: The hospice and palliative medicine education provided medical students in Taiwan remains inadequate. Institutionalizing a curriculum that includes practicum and experiential methodology, which would help medical students achieve basic competency in end-of-life care, would be the best approach to improving the attitude and understanding of Taiwan’s future physicians toward hospice-palliative care.