隨著醫療與公共衛生的進步以及全民健康保險的實施，高齡人口就醫的比例逐年上升。然而，由於緩和醫療尚未普及，當高齡患者面臨心跳停止等緊急情況時，醫院仍必須實施積極的急救治療，常常不僅無法延長壽命，反而增加了病人的痛苦。為了解急診緩和醫療之現況與困難，本研究欲透過急診心跳停止病人之不施行心肺復甦術（DNR）決策時機與醫療處置、費用和存活率進行探討與分析。
　　本研究以台灣北部某準醫學中心2021年於急診心跳停止之病歷，排除不符合研究主題案例後，共376例進行分析。分析後發現，愈晚進行DNR決策會執行愈多醫療處置；醫療費用隨著醫療處置的執行而增加，未簽署DNR的醫療費用是到院前即簽署DNR者的2倍；未簽署DNR者存活出院率為13.04%，平均存活年齡為61.26歲，且研究發現愈早簽署DNR的病患在急診待床時間愈久。
　　若能即早了解並同意簽署DNR，可以減少患者在發生緊急狀況送至急診時造成額外的痛苦，同時減少不必要的處置及所造成的醫療浪費。為實現此目標，我們應增加對緩和醫療的投入，提供適合的空間、設備以及團隊幫助病人與家屬；我們也建議從教育、系統、溝通與政策上強化緩和醫療的觀念，「預立醫療決定」是所有人都需要知道的事，期許更多人能「善終」，達到病人、家屬、醫護人員、醫院、政府多贏的目標。

With the advancements in public healthcare, as well as the implementation of National Health Insurance in Taiwan, the proportion of elderly patients seeking medical care has been increasing annually. However, due to the concept of palliative care has not become popular, medical staffs are still required to administer aggressive emergency treatment to elderly patients experiencing cardiac arrest, often failing to prolong their lives and instead increasing their suffering. This study aims to explore the current status and challenges of palliative care in emergency departments by examining the timing of Do-Not-Resuscitate (DNR) decisions, medical interventions, costs, and survival rates in cardiac arrest patients.
This study analyzed 376 cases from a medical center in northern Taiwan in 2021, after excluding cases that did not meet the research criteria. The results showed that the later a DNR decision was made, the more medical interventions were performed; the medical expenses of patients who did not sign a DNR are twice that of patients who did before arrival. The survival discharge rate for patients without a DNR was 13.04%, with an average survival age of 61.26 years. Moreover, the study found that patients who signed a DNR earlier experienced longer waiting times in the emergency department.
Understanding and agreeing to sign a DNR early can reduce the additional suffering of patients, as well as decrease unnecessary medical procedures and associated costs. To achieve this goal, efforts should be made to increase investment in palliative care, providing appropriate space, equipment, and support teams for patients and their families. It is also recommended to strengthen the concept of palliative care through education, system integration, communication, and policy. “Advance decision” is essential for everyone to understand, and it is expected that more people can achieve a "good death", which may benefit patients, families, healthcare providers, hospitals, and the government.

摘要 I
ABSTRACT II
誌謝辭 III
第一章 緒論 1
第一節 研究背景 1
第二節 緊急救護與安寧緩和醫療 4
第三節 研究目的 10
第二章 文獻探討 12
第一節 名詞解釋 12
第二節 急診推動緩和醫療困境 18
第三節 臨終決策 20
第三章　實證資料描述 23
第一節 資料來源與變數說明 23
第二節 信效度 28
第四章　結果與分析 29
第一節 敘述統計 29
第二節 迴歸分析結果 33
第五章　結論與建議 43
第一節 結論 43
第二節 建議 44
第三節 研究限制 48
參考文獻 49

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