社會行銷應用於推動安寧緩和醫療之探討

Applications of Social Marketing in Promotion of Palliative Care

根據衛生福利部2006至2018年的統計資料顯示，已簽署的預立安寧緩和醫療暨維生醫療抉擇書約有50萬份。從逐年增加的意願書可以瞭解到民眾逐漸重視自己的權益，但是從抉擇書的總數仍偏低看來，絕大部分民眾可能對於安寧緩和醫療的認識仍不足。安寧緩和醫療推動效果不如預期是否與醫療政策認知觀念的差異有關，值得深入探討。研究目的:一、談社會行銷觀點出發，家屬透過認知轉變，才有行為轉變。二、探討醫療背景的家屬與非醫療背景的家屬是否認知觀念有明顯的落差。本研究屬於質化分析，採用立意抽樣方式選取樣本為30至60歲曾經照顧末期病人的家屬，分為具有醫護背景及非醫護背景兩組。從三方面進行分析探討：一、面對死亡與安寧療護的認知；二、安寧療護面臨的挑戰；三、安寧療護推動的要素。以認知結構圖來呈現分析結果，期待使用者或家屬面臨需求困境的時候，能夠適時利用社會行銷給予回應，讓民眾能重新思考安寧療護對於維護生命品質的價值，未來能透過「預立醫療自主計畫」積極維護生命的品質與價值，減少無效醫療的使用。有效的滿足社會行銷中的需求，改變社會行為，產生社會公共利益，減少醫療資源的浪費。

According to the report of the Ministry of Health and Welfare, from 2006 to 2018, about 500,000 copies of the pre-medical decision have been signed. The increasing signing shows that people gradually pay attention to their own rights and interests. The low rate of signing shows that the most people may still have insufficient understanding of palliative care. The poor effect of promoting palliative care may relate to the differences in medical cognition. Purposes: (1) Setting out with social marketing concept to discuss that altering family’s behavior through changing the perception. (2) Exploring if there is obvious difference in perception of Palliative Care between family with medical background and non-medical background. This study is a qualitative analysis. The people selected by purposive sampling, from 30 to 60 years old, who has taken care of the terminal patient in their family. Those people divided into two groups with medical background or not. Using knowledge structure to analyze and present from three aspects: (1) The level of awareness of death and hospice care; (2) The challenges of hospice care; (3) The elements promoted by hospice care. Allow those in need to get a response from social marketing in a timely manner. Let the public rethink how to keep the quality of life by signing pre-medical decision. We hope Advance Care Planning (ACP) could effectively change social behavior, generate social public benefits, avoid ineffective medical care, reduce the waste of medical resources in the future, and keep the quality and value of life.