我國慢性腎臟疾病盛行率高居世界第一，也因透析醫療品質的嚴格管控，使得病 人存活期延長，但在漫長的透析治療中，其生活品質及合併症所耗費的醫療支出，是 透析醫護團隊需要正視的隱憂，讓病人面臨疾病末期時選擇不必要的醫療和有尊嚴的 生活品質是重要的議題，因此專案目的在提高病人預立安寧緩和醫療暨維生醫療抉擇 意願書簽署率，讓病人能自主選擇，檢視單位 2015 年意願書簽署率 1.37％，深入的 探討原因，經現況調查及特性要因圖分析原因，主要為缺乏意願書教育訓練、無作業 標準、缺乏推廣，藉由跨團隊合作舉辦教育訓練、制定作業標準、實際推廣活動等措 施，簽署率在 2016 年由 1.37％ 提升至 7.58％，除達目標值之外，持續改善效果維 持一年後達 22.1％，可作為血液透析推廣安寧療護之參考。

Taiwan has the highest prevalence rate of chronic renal disease, and its strict control over the quality of dialytic therapy has prolonged the lives of patients. However, longterm dialytic therapy raises concerns regarding the quality of life and medical expenses associated with complications. As a result, the issue of whether patients in the late stages of their diseases may refuse treatment and choose to live their lives with dignity, is an important one. This project sought to increase the take-up rate of the Hospice Palliative Care & Life- Sustaining Treatment Advance Care Plan among patients in order to allow them to make independent choices. The take-up rate among patients from the institutions surveyed in the study was 1.37% (4/290) in 2015. Reasons were analyzed by conducting a survey and plotting a cause & effect diagram. The main reasons included the lack of education/training, absence of operating standards, and lack of promotion. Inter-team cooperation and education/ training, the establishment of operating standards and the promotion of activities increased the take-up rate from 1.37% (4/290) to 7.58% (22/290). The results can serve as reference for the promotion of hospice care in the field of hemodialysis.