從國內居家整合照護計畫探討安寧緩和整合照護模式新契機

In the rapidly aging society where cancer is the main cause of death in Taiwan, the integration of healthcare, palliative care, and hospice care has become an important issue of current healthcare system revolution. Both the domestic and foreign tends are to improve cancer care quality. One of the important steps is to integrate hospice and palliative care with cancer treatment, and the key quality indicator for successful integration is the proportion of patients receiving hospice and palliative care (coverage of hospice care) in the 6 months prior to death. The government is currently promoting the ＂2019 Home-based Integrated Care Program＂ to include the ＂hospice care situation within 6 months prior to the death of patients＂ into the monitoring indicators. The Program emphasizes the importance of hospice and palliative integrated care of patients with end-stage cancer. The foreign palliative care uses interdisciplinary professional teams to provide palliative care as the best model for home-based care. This study investigates the difference between the current home-based integrated care in Taiwan and foreign palliative integrated care, in the hopes to provide the research results as reference for the government to promote early palliative care in the future. Successful promotion of home-based hospice and palliative integrated care is dependent upon: (1) medical centers' discharge preparation service and downstream referral physicians' and free-standing agency development of vertical integrated process, bridging patient care issues, and strengthening of professional visits by traditional Chinese medical practitioners, dentists, and pharmacists; (2) inclusion of the Advance Care Planning (ACP) courses into the hospice care continued education in line with the promulgation of the Patient Right to Autonomy Act; (3) development of early palliative care training courses and early hospice and palliative care program for assisting patients with end-stage cancer; (4) promotion of other specialists' participation in hospice and palliative care teams to improve the accessibility of home-based hospice care for patients with end-stage cancer and their family members and to enable them to continuously receive care at home and fulfill the wish of good death at home.