「壽終正寢」、「落葉歸根」是台灣文化根深蒂固的觀念，預估生命存活期有助於醫療團隊了解病人及家屬的餘生期待，以便作完整的善終準備。本研究於南部某醫學中心以立意取樣，藉由病歷回顧的方式，依循經由廣泛性文獻查證，再參照臨床實務經驗，所擬定的「臨終症狀及臨死覺知評估表」作為研究工具，收集癌末病人臨終症狀、臨死覺知與其死亡時間，藉此探討台灣文化中末期癌症病人臨終症狀。
研究結果發現，總樣本數為121位末期癌症病人，死亡地點在安寧病房者占57.9%，提前回家22.3%，留一口氣回家19%，病人平均年齡63.1歲（SD=14.1），Palliative Prognostic Index（PPI）平均值為11.2，每位病人平均出現7.6種臨終症狀。臨終症狀發生率由高至低依序為：發紺冰冷（98.3%），至死亡日平均3.4天；鏡面舌（93.4%），至死亡日平均8.5天；耳垂縮（93.4%），至死亡日平均5.6天；陳氏呼吸（91.7%），至死亡日平均0.53天；煩躁不安（78.5%），至死亡日平均7.7天；死前嘎嘎聲（Death rattle）（65.2%），至死亡日平均0.89天；陰莖（囊）縮（54.4％），至死亡日平均10.1天；末期躁動（37.1%），至死亡日平均9.9天；鞏膜水腫（33.1%），至死亡日平均10.1天；譫妄（28.9%），至死亡日平均9.4天；夢到過世親人（11.5%），至死亡日平均11.4天。死亡當天意識清醒者占7.4%；嗜睡占6.6%；木僵占18.1%，半昏迷占48.7％，昏迷占19％。臨死覺知的內容有：(1).病人自己感覺來日不多（71.1%），至死亡日平均7.3天；(2).死亡準備交代（64.5%），至死亡日平均8.1天；(3).想回家（45.5%），至死亡日平均9.2天。99.2%臨終病人淋巴球指數低於正常，此平均值為5.3%，至死亡日平均4.7天。預估生命存活期若能參照臨終症狀和臨死覺知發生率，則更能精準掌握以「日」計算之存活預估。
本研究結果提供實證基礎，可作為末期照護的背景知識藉此提升照護知能，以便更準確地預估病人死亡時日，以利病人及其家屬作善終準備，減少生死兩不安，提升末期病人之照護品質。

Introduction:
In Taiwan "to pass away peacefully" is an important and meaningful concept for traditional culture, and people hope to take last sleep at home near end of life. If health care professional can not estimate life expectancy precisely, family goes mad with grief and feels guilty. Besides, health care professional are also frustrated due to the event. So it is a major objective to estimate life expectancy precisely for us.

Materials and Methods:
This study was performed through charts review, and collected terminal cancer patients dying symptoms, death awareness and dead time for analysis. We tried to search literatures, accumulate clinical experience, find our knowledge gap, and set up ”the scale of end-of-life signs and symptoms and death awareness” as our tool. Data collection was total 14 months from Dec. 2010 to Feb. 2012, and we enrolled 121 terminal cancer patients in a southern medical center. We used the scale to assemble end-of-life signs and symptoms, death awareness and dead time to discover “the concepts of terminal patients end-of-life signs and symptoms in Taiwan".

Results:
We found that the choice of death place was 57.9% at hospice, 41.3% at home from 121 terminal cancer patients. The mean age was 63.1 years (SD=14.1), and the mean Palliative Prognostic Index (PPI) was 11.2. There were 7.6 dying symptoms per patient. The incidence of dying symptoms was 98.3% cold and cyanosis (average 3.4 days to death), 93.4% mirror-like tongue (average 8.5 days to death), 93.4% earlobe shrinking (average 5.6 days to death), 91.7% Cheyne-stokes respiration (average 0.53 days to death), 78.5% restlessness (average 7.7 days to death), 65.2% death rattles (average 0.89 days to death), 54.4% penis shrinkage (average 10.1 days to death), 37.1% terminal agitation (average 9.9 days to death), 33.1% turbid sclera with edema (average 10.1 days to death), 28.9% delirium (average 9.4 days to death), 11.5% Dream of dead relatives and friends (average 11.4 days to death). Death awareness could be divided to: (1). 71.1% patients felt close to death (average 7.3 days to death), (2). 64.5% a preparation to death (average 8.1 days to death),(3). 45.5% patients hoped to go home (average 9.2 days to death). The lymphocyte count in 99.2% end of life patient was lower than normal limit, The mean lymphocyte count was 5.3% (average 4.7 days to death). It will be accurate to estimate life expectancy by observing end-of-life signs and symptoms and death awareness.
Conclusion:：
The results can provide evidence for clinical practice, offer knowledge and techniques for health care providers, and increase quality of life for terminal cancer patients.
Key word: terminally ill cancer patients、signs and
symptoms on end-of-life、 Estimated life survival
、death awareness

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