安寧緩和照護透過及早介入與全人照護，回應病人及家屬在身體、心理、社會與靈性層面的需求，協助病人維持生活品質並積極生活至生命終點。為確保照護品質並持續改進，台灣參照澳洲的安寧緩和照護成效合作，於2020年推動台灣安寧緩和照護品質監測計畫(Taiwan Palliative Care Outcomes Collaboration, TPCOC)，透過標準化的臨床評估工具，監測症狀改善情況，並為臨床決策提供依據。若可進一步瞭解不同安寧緩和照護模式對病人症狀改善之成效及其相關因素，可幫助醫療團隊選擇最合適病人之照護模式。因此，本研究目的為探討安寧緩和照護模式及相關因素對末期病人症狀改善成效之關聯，以及不同照護模式介入後症狀變化之趨勢。
本研究採回溯性次級資料分析，收集2022年至2025年南部某醫學中心TPCOC資料庫之病人資料，並以廣義估計方程式分析。由於死亡地點僅適用於已死亡個案，若納入主要模型將造成無死亡地點資料之個案無法進入分析，故本研究另針對有死亡地點資料之已死亡個案進行獨立分析。研究共納入4762位病人，TPCOC總評估次數36830次，結果顯示，不同年齡階層病人部分生理症狀改善程度有顯著差異；不同安寧緩和照護模式、疾病類型(癌症或非癌症)及不同功能狀態病人之部分生理及心理症狀改善程度亦有顯著差異；不同性別病人之生理及心理症狀改善程度則無顯著差異。整體而言，症狀改善成效與不同安寧緩和照護模式、年齡、疾病類型及功能狀態等因素具相關性，此外，已死亡個案之獨立分析顯示，不同死亡地點(機構或家中)者在部分生理症狀變化上亦呈現差異。研究亦發現，不同照護模式與症狀改善趨勢有所不同。其中安寧病房呈現較穩定之整體症狀改善趨勢，而安寧共照與安寧居家則較早呈現症狀分數下降之趨勢。依據研究結果，建議臨床上可持續運用標準化的評估工具追蹤病人症狀變化，及早辨識症狀改善有限或持續惡化之病人，並依病人之年齡、疾病類型、功能狀態及症狀變化，評估其照護需求，選擇適切之安寧緩和照護模式。此外，死亡地點之相關結果可作為預立照護計畫及臨終照護安排之參考。

Palliative care addresses the physical, psychological, social, and spiritual needs of patients and their families through early, holistic, patient-centered care. Taiwan launched the Taiwan Palliative Care Outcomes Collaboration (TPCOC) in 2020 to support continuous quality improvement. This study aimed to examine the associations between palliative care models and symptom improvement among terminally ill patients. This retrospective secondary data analysis used data from the TPCOC database of a medical center in southern Taiwan from 2022 to 2025. Generalized estimating equations were used to analyze the associations of palliative care models and related factors with symptom improvement. Because place of death was applicable only to deceased patients, a separate analysis was conducted among deceased patients with available place of death data. The results showed that changes in Symptom Assessment Scale and Palliative Care Problem Severity Score were associated with palliative care models, age, disease type, and functional status. Among deceased patients, differences in changes in some symptoms were observed according to place of death. Different palliative care models were also associated with distinct trajectories of symptom improvement. Inpatient palliative care showed a more stable overall trend of symptom improvement, whereas palliative shared care and home palliative care showed earlier declines in symptom scores. These findings may assist healthcare teams in selecting appropriate palliative care models according to patients’ needs and allocating clinical care resources to improve the quality of care for terminally ill patients.

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