本研究主要在探討加護病房中老年病人及家屬對於「預立醫療指示」的認知觀念、感受與過去經驗以及決策考量、決策態度、決策參與，和決策意向的現況與相關性，並了解中老年病人及家屬之間是否有差異性。研究為橫斷式、描述性研究，採立意取樣，於中部某醫學中心內科加護病房進行收案，研究對象為加護病房病人及家屬，收案數病人30人、家屬65人，使用結構式問卷設計，以李克特氏5分量表詢問研究對象對於「預立醫療指示」的認知觀念等各面向的看法，所得資料以SPSS 20.0統計軟體進行資料建檔及統計，做描述性與相關因素之分析，研究發現如下：
一、 對於「預立醫療指示」的認知，包括心肺復甦術措施、維生醫療措施、不予心肺復甦術、不予維生醫療以及簽署同意書注意事項等，病人及家屬了解程度多為不確定。
二、 對於心肺復甦術措施的感受，病人及家屬多認為痛苦，尤其氣管內插管、心臟電擊。
三、 對於心肺復甦術措施的過去經驗，病人及家屬大多數曾經聽過或看過心肺復甦術治療；有一半的病人曾經親身經歷過心肺復甦術的治療措施，其中全都接受過氣管內插管的治療；在醫院內接觸過「預立醫療指示」相關內容宣導或介紹者，只佔3.3%-4.3%；參與「預立醫療指示」決策經驗方面，病人有2人(6.7%)、家屬有24人(36.9%)；曾有討論過「預立醫療指示」的經驗者，病人有4人(13.3%)、家屬有33人(50.8%)。
四、 對於「預立醫療指示」的決策考量，內容為不施行心肺復甦術及不施行維生醫療的決策考量，病人認為當事人的意願最重要，其次是疾病嚴重度，家屬認為疾病嚴重度最重要，其次是與醫療人員共同討論。病人及家屬一致認為病情出現變化時是最好的討論時機。
五、 對於「預立醫療指示」的決策態度，在急救與「預立醫療指示」相關決定上有什麼看法，病人及家屬的態度傾向中立。在決策參與的部分，面臨「預立醫療指示」，有21位病人(70.0%)認為應該自己優先做決定，有35位家屬(53.8%)認為應該由病人自己做決定。
六、 對於「預立醫療指示」的決策意向，不施行心肺復甦術有13位病人(43.3%)願意簽署；施行維生醫療處置有24位病人(80%)會聽從醫療人員建議；若為生命末期，且無法治癒，有5位病人(16.7%)願意轉至安寧病房照護；大部分病人並不同意簽署器官捐贈。不施行心肺復甦術有29位家屬(44.6%)願意代理簽署；施行維生醫療處置有43位家屬(66.2%)會聽從醫療人員建議；若為生命末期，且無法治癒，有27位家屬(41.5%)願意將病人轉至安寧病房照護；大部分家屬並不同意簽署器官捐贈。決策的進行以醫生、病人與家屬共同決定治療方式為首選。

七、 加護病房病人已婚狀態、高中以上教育程度以及主要照顧者為配偶者，對於「預立醫療指示」的認知較高，病人APACHE II的分數在16分以上者和主要照顧者為配偶者，對於「預立醫療指示」的決策態度較正向。
八、 加護病房家屬為專科以上教育程度、經濟狀況月收入高於35000元以上者，對於「預立醫療指示」的認知較高，家屬經濟月收入高於35000元以上者、為主要決策者、主要照顧者以及患病親人的日常功能活動為完全自理者，對於CPR的感受相較痛苦，家屬為專科以上教育程度、無宗教信仰者、患病親人的教育程度「國中」者，對於「預立醫療指示」的決策態度較正向，家屬教育程度「國、高中」者、宗教信仰「佛、道教」者，對於預立醫療指示比較容易做出決策。
九、 病人對於「預立醫療指示」的認知愈高，對心肺復甦術的感受愈強、愈覺的痛苦，對於「預立醫療指示」的決策態度也會愈正向。
十、 家屬對於「預立醫療指示」的認知愈高、對心肺復甦術的感受愈強、愈覺的痛苦，對於「預立醫療指示」的決策態度愈正向；但相對的，當家屬對於心肺復甦術的痛苦感受愈低、決策態度愈偏負向，則愈不易做出決策。
十一、 成對病人和家屬彼此對「預立醫療指示」的認知與決策，有顯著差異性的是決策態度。
期待研究結果有助於釐清本地對於「預立醫療指示」的現況，在臨床上能提供更適切的照護，並做為後續執行預立醫療指示的推廣及研究之參考。

SUMMARY

Objective: To investigate the elderly patients in the intensive care units (ICUs) and their families for awareness, feelings, past experiences, attitudes and willingness to decide advance directives, as well as considerations and intentions of decision-making in advance directives, and the associated factors, and to compare the difference between patients and their families.
Methods: A cross-sectional and descriptive study with purposive sampling was conducted at medical ICUs of a medical center in middle Taiwan. Patients aged ≥ 55 years and admitted at medical ICUs and their families were enrolled. A total of 30 patients and 65 family members were enrolled.
Results: The majority of participants were not aware of advance directives. Less than 5% of patients and family members had ever contacted about the advance directives. About 13% of patients and 50% of families had discussed about advance care planning. Condition change is the best timing to discuss this issue. Both patients and family members recognized the patient himself should be the prioritized decision-maker. As to directions of decision-making, 43.3% of patients and 44.6% of family surrogate agreed to sign DNR. There were different attitudes toward awareness and decision making of advance directives between patients and family members.
Conclusion: The fact that most of the respondents had never heard about advance directives or discussed the concept with others points to a lack of knowledge and to the necessity to step up public education about such issues.

Keywords: Advance directives, awareness, decision making, intensive care

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