目標:台灣截至2018年4月，65歲以上的老年人口數已占總人口比率14.10%。隨著人體器官逐年衰老，高齡者可能需要藉由呼吸器、鼻胃管甚至葉克膜來維持身體的機能，因此臨終前之健保醫療費用也甚高。台灣於2016年公布「病人自主權利法」，並將於2019年實施，以提高其簽署預立醫療決定之比例。本研究調查台灣中老年人對病人自主權利法之知識、態度與行為間之相關與其影響因子。

方法: 採橫斷式調查研究設計，自填式結構問卷設計以KAB(knowledge, attitudes and behaviors)模式為基礎，研究對象為40歲以上社區活動中心、公園與網路之民眾。統計方法包含Pearson correlation、One-way ANOVA、T-test與Multiple Regression。

結果:共完成有效問卷446份(回收率93.5%)。研究顯示中老年者對病人自主權利法之知識、態度、行為之間有顯著正相關。人口學變項中，每月可支配之金額對知識有相關。年齡、每月可支配之金額、教育、婚姻狀態與態度有相關。深入探討後發現，信仰佛教、家中有父母/子女/配偶者知識分數顯著較低，且月可支配金額5001~10000組也顯著低於50001以上之組別。喪偶組在態度分數上較未婚組別低。

結論: 建議對於特定信仰、收入與家中組成成員之族群，依其特性訂定宣導策略，增加其對資訊之了解，進而提升對此法條之態度，提高其簽署預立醫療決定之比例。達到人人皆能善用預立醫療決定、提升病人自主權、減少無效醫療之花費並促進台灣醫療永續發展。

Objectives: As of April 2018, old people aged 65 and over have accounted for 14.1% of Taiwan population. Health expenditures for old people who require ventilators, nasogastric tubes, or extra-corporeal membrane oxygenation (ECMO) during end of life care could be high. The Taiwanese government published Patient Autonomy Act (PAA) in 2016, and is going to implement the Act in 2019 to increase the sign up rate of advance care planning. The present research investigates knowledge, attitude and behavior among middle-aged and old people toward PAA.
Methods: The present study adopts a cross-sectional survey design and uses questionnaire as a survey instrument. The knowledge, attitudes and behaviors (KAB) model is applied in designing the questionnaire. The survey sample includes people aged 40 and over from community centers, parks and the internet. The statistical methods used include t-tests, ANOVA, and multiple linear regressions.
Results: A total number of 466 questionnaires are included in this analysis, which is equivalent to 93.5% of the questionnaires collected. The results show that among middle-aged and old people, the knowledge, attitude and behavior toward PAA are positively correlated. Among various demographic factors, both age and marital status are correlated with attitude; disposable income(DI) is correlated with knowledge and attitude, and education is correlated with attitude and behavior. A further investigation shows that people who are Buddhists, have disposable monthly income between 5,001 and 10,000 NTD, or live with parents/children/spouse have lower scores for knowledge. The widowed have lower scores for attitude. The scores for attitude are significantly different for people with different monthly disposal income and education levels. People with different education levels also have significantly different scores for behavior.
Conclusion: On the basis of results from the current study, we suggest that government tailors promotion strategies for PAA to individual groups which have different demographic backgrounds. This may increase people’s understanding of and improve their attitude toward PAA, and finally increase the sign up rate of advance care planning.

論文審定書 i
致謝 ii
摘要 iii
ABSTRACT iv
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究問題 3
第三節 目的與預期貢獻 3
第二章 文獻探討 5
第一節 病人自主權利法 5
第二節 知識、態度、行為模型 6
第三節 國外對預立醫療決定與諮商的知識、態度、行為之相關文獻 8
第四節 國內對預立醫療決定與諮商的知識、態度、行為之相關文獻 10
第五節 影響預立醫療決定與諮商之相關因素 11
第三章 研究方法 13
第一節 研究假設 14
第二節 問卷設計與資料收集 14
第三節 問卷的信效度 18
第四章 研究分析與結果 23
第一節 描述性統計分析 23
第二節 中老年人對病人自主權利法之知識、態度、行為間的關係 29
第三節 影響知識、態度、行為之人口學因素 29
第四節 影響知識、態度、行為之因素-迴歸分析 33
第五節 驗證假設之結果 38
第五章 討論 39
第六章 結論與建議 42
第一節 研究結論 42
第二節 研究限制與未來研究建議 42
第三節 政策建議 43
參考文獻 45
附錄一、 名詞定義 49
附錄二、 病人自主權利法 50
附錄三、 專家效度名單 56
附錄四、 專家效度檢核表 57
附錄五、 試題分析與項目分析 62
附錄六、 因素分析 66
附錄七、 正式問卷 70

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