【新學術文章】運用社會生態學模式檢視香港長者晚期護理服務中的問題和相對完善發展所存在的差距 – 香港多元化定性研究
在現今醫療服務中，為絕症及重症病人提供的晚期護理服務備受關注。儘管香港人的預期壽命為全球之冠，而近年對相應的長期護理服務的需求也不斷上升， 香港的晚期護理服務多年來發展並不完善。是次研究目標在於針對香港長者晚期護理服務中的問題作出整體性的檢視和表述。研究使用多元化定性方法進行數據收集，包括焦點小組和與關鍵人物和持份者的深入訪談，以及對患者和家屬的縱向案例研究。研究透過主題分析，從社會生態模型的角度仔細檢視香港當前晚期護理服務在不同層面上存在的問題和差距，以及他們之間的關係。透過該模型，我們在政策、法律、社區、機構以及個人和人際層面上總結了針對香港老年人口的晚期護理服務上的差距和問題。這些包括但不限於缺乏全面的晚期護理政策框架、精神上無行為能力的法律依據含糊、針對預設醫療指示的立法障礙、社區內對晚期護理服務的供應及所需資源和支援的缺乏、醫療和社福領域裡對晚期護理的認知及培訓上之有限、以及就服務在兩種領域服務上所需的連接和整合的欠缺。另外，在文化層面上香港人對有關死亡的話題存在一定的恐懼和抗拒心態，而且對孝道的文化詮釋也帶來一定包袱。以上種種因素都有可能加重垂死患者的痛苦。研究結果突顯了在一個東西文化交彙的地方，晚期護理服務存在多層次的障礙和問題，並闡明如何最好地設計更有效、更全面的政策干預措施，以有利發展可持續、以人為本的晚期護理服務。
【New academic publication】Examining the Gaps and Issues of End-of-Life Care among Older Population through the Lens of Socioecological Model—A Multi-Method Qualitative Study of Hong Kong
End-of-life (EOL) care for terminal illness and life-limiting conditions is a sector in the health service spectrum that is drawing increased attention. Despite having the world’s longest life expectancy and an ever-escalating demand for long-term care, Hong Kong’s EOL care was underdeveloped. The current study aims to provide a holistic picture of gaps and issues to EOL care in Hong Kong. Data collection was conducted using a multi-method qualitative approach that included focus groups and in-depth interviews with key informants and stakeholders, and longitudinal case studies with patients and families. Deductive thematic analysis was used to examine service gaps in current EOL care through the lens of a socioecological model where gaps and issues in various nested, hierarchical levels of care as well as the relationships between these levels were studied in detail. Using the model, we identified gaps and issues of EOL care among older populations in Hong Kong at the policy, legal, community, institutional, as well as intrapersonal and interpersonal levels. These include but are not limited to a lack of overarching EOL care policy framework, ambiguity in the legal basis for mental incapacity, legislative barriers for advance directives, inadequate capacity, resources, and support in the community to administer EOL care, inadequate knowledge, training, and resources for EOL care in health and social care sectors, inadequate medical-social interface, general reluctance and fear of death and dying, as well as the cultural interpretation of filial piety that may lengthen the suffering of the dying patients. Findings highlight the multi-level gaps and issues of EOL care in a place where western and eastern culture meet, and shed light on how best to design more effective and comprehensive policy interventions that will likely have a more sustainable and instrumental impact on facilitating person-centered EOL care during the end of life.
