本研究以既有研究較少探究之生命末期醫療決策為主題，探究訊息設計之傳播 效果。在前導研究的部分，本研究透過與一線推廣人員的深度訪談，對臺灣推廣安 寧療護、生命末期醫療決策等議題現狀有所了解。於後，透過實驗，將能個別了解 訊息元素之於民眾的傳播效果。以下將分別從方法面及實務面進行討論，期望未來 研究者與實務工作者在做相關研究或事務時，能從此得到一些啟發。
一、研究方法與設計之限制與建議 其填答（Thibault‐Prevost et al., 2000）。
生命末期醫療決策是一複雜的過程，病人、家屬、醫療服務提供者、重要他人 等皆會影響個人的決策（Thibault‐Prevost et al., 2000）；因此，在研究方法上，實地 研究亦不失為一個考量，亦即進入生命末期醫療決策議題的真實推廣情境，是否能
響，而未必純粹因閱讀訊息致使行為的發生；故本研究基於倫理、成本與時間限制，
（二）訊息設計之把關面
參考文獻
天下雜誌、參玖參公民平台（2014）。臨終前無效醫療研究報告書。上網日期 2015 年 11 月 9 日，取自 http://393citizen.com/report.php
方慧芬、張慧玉、林佳靜（2009）。末期病人面臨預立醫囑、生前預囑之現況及與生 自 http://www.hospice.org.tw/2009/chinese/qa-3.php
曲幗敏（2011）。簽署不予施行心肺復甦術癌症病人照顧者家屬的感受與其相關因素
行政院衛生福利部（2017）。安寧緩和醫療及器官捐贈意願資訊系統。上網日期 2017 年 2 月 8 日，取自 https://hpcod.mohw.gov.tw/HospWeb/
行政院衛生福利部國民健康署（2015）。齊心合力安寧善終；臺灣再創亞洲第一 透 過病情告知讓罹癌者擁有自主人權。上網日期 2016 年 1 月 6 日，取自 http://www.mohw.gov.tw/news/531752444
行政院衛生福利部醫事司（2015）。保障病人自主，病人自主權利法三讀通過！。上 網日期 2016 年 2 月 16 日，取自 http://www.mohw.gov.tw/news/531953241 何怡萍（2014）。回顧世界安寧日在台十年。安寧照顧會訊，87，4-5。
李瑟（2010）。DNR 是整個社會的事。康健雜誌，141，204-205。
李蘭等人（2010）。健康行為與健康教育。臺北市：巨流。
自 http://www.cw.com.tw/article/article.action?id=5071899
徐明儀、江蓮瑩（2014）。無效醫療議題之探討。護理雜誌，61（1），99-104。
徐淑惠（2013）。成人對安寧療護認知與態度之調查研究。國立臺北教育大學教育學 系碩士論文。
財團法人臺灣醫療改革基金會（2014）。醫改會推《醫病五溝通》 向無效醫療說 STOP。
上網日期 2015 年 11 月 9 日，取自 http://www.thrf.org.tw/Page_Show.asp?Page _ID=1991
財團法人臺灣網路資訊中心（2015）。臺灣寬頻網路使用調查報告。上網日期 2016 年 10 月 10 日，取自 http://www.twnic.net.tw/download/200307/20150901e.pdf 高以信、王昱豐、江瑞坤（2011）。末期病人的預後：醫療照護團隊需要再進修的課
題。臺灣醫學，15（5），551-562。
張卿卿（2004）。從性別差異與產品態度確定性高低來探討廣告框架效果。管理評論，
23（1），1-23。
郭淑珍（2013）。網路對癌症病人疾病經驗的影響。臺灣醫學人文學刊，14（1&2），
陳玉真（2015）。新北市國小教師簽署「預立安寧緩和醫療暨維生醫療抉擇意願書」
意圖研究—計畫行為理論之應用。國立臺北教育大學教育學系碩士論文。
陳立言（2004）。生命教育在臺灣之發展概況。哲學與文化，31（9），21-46。
陳佳佳（2014）。生命盡頭的尊重。全民健康保險雙月刊，111，10-15。 年 10 月 11 日，取自 http://www.ixresearch.com/news/comscore%E8%88%87%E 5%89%B5%E5%B8%82%E9%9A%9B%E4%BE%9D%E6%93%9Acomscore-mm
楊克平（1999）。論緩和療護之意義及其變化史。榮總護理，16（4），357-363。
溫信財、白璐、陸汝斌（1987）。台北市古亭、龍山區成人之生活壓力知覺及其相關
蔡明昌（2014）。大學生死亡焦慮的內涵建構與現況調查之研究。中華輔導與諮商學 Decision Processes, 50(2), 179-211.
Ajzen, I. (2012). Martin Fishbein’s legacy the reasoned action approach. The Annals of the American Academy of Political and Social Science, 640(1), 11-27.
Ajzen, I., & Fisbbein, M. (1974). Factors influencing intentions and the intention-behavior relation. Human Relations, 27(1), 1-15.
Albers-Miller, N. D., & Stafford, M. R. (1999). An international analysis of emotional and rational appeals in services vs goods advertising. Journal of Consumer Marketing, 16(1), 42-57.
Back, A. L., Arnold, R. M., Baile, W. F., Fryer-Edwards, K. A., Alexander, S. C., Barley, G. E., . . . Tulsky, J. A. (2007). Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Archives of Internal Medicine, 167(5), 453-460.
Backer, T. E., Rogers, E., & Sopory, P. (1992). Designing health communication
Bart, Y., Stephen, A. T., & Sarvary, M. (2014). Which products are best suited to mobile advertising? A field study of mobile display advertising effects on consumer attitudes and intentions. Journal of Marketing Research, 51(3), 270-285.
Bartels, R. D., Kelly, K. M., & Rothman, A. J. (2010). Moving beyond the function of the health behaviour: The effect of message frame on behavioural decision-making.
Psychology and Health, 25(7), 821-838.
Basu, A., & Dutta, M. J. (2008). The relationship between health information seeking and community participation: The roles of health information orientation and efficacy.
Health Communication, 23(1), 70-79.
Batra, R., & Stayman, D. M. (1990). The role of mood in advertising effectiveness.
Journal of Consumer Research, 17(2), 203-214.
Belinson, J. L., Wang, G., Qu, X., Du, H., Shen, J., Xu, J., . . . Wu, R. (2014). The development and evaluation of a community based model for cervical cancer screening based on self-sampling. Gynecologic Oncology, 132(3), 636-642.
Bell, R. A., McGlone, M. S., & Dragojevic, M. (2014). Bacteria as bullies: Effects of linguistic agency assignment in health message. Journal of Health Communication, 19(3), 340-358.
Bettinghaus, E. P. (1986). Health promotion and the knowledge-attitude-behavior continuum. Preventive Medicine, 15(5), 475-491.
Bettman, J. R., & Sujan, M. (1987). Effects of framing on evaluation of comparable and noncomparable alternatives by expert and novice consumers. Journal of Consumer Research, 14(2), 141-154.
Briñol, P., & Petty, R. E. (2006). Fundamental processes leading to attitude change:
Implications for cancer prevention communications. Journal of Communication, 56(s1), S81-S104.
analysis of HPV vaccine coverage on YouTube. Health Communication, 27(5), 478-485.
Brosschot, J. F., Gerin, W., & Thayer, J. F. (2006). The perseverative cognition hypothesis:
A review of worry, prolonged stress-related physiological activation, and health.
Journal of Psychosomatic Research, 60(2), 113-124.
Bryant, J., & Oliver, M. B. (2008). Media effects: Advances in theory and research (3rd edition). London：United Kingdom: Routledge.
Chadwick, A. E. (2015). Toward a theory of persuasive hope: Effects of cognitive appraisals, hope appeals, and hope in the context of climate change. Health Communication, 30(6), 598-611.
Chadwick, A. E., Zoccola, P. M., Figueroa, W. S., & Rabideau, E. M. (2016).
Communication and stress: Effects of hope evocation and rumination messages on heart rate, anxiety, and emotions after a stressor. Health Communication. doi:
10.1080/10410236.2015.1079759
Chang, C. (2006). Changing smoking attitudes by strengthening weak antismoking beliefs—Taiwan as an example. Journal of Health Communication, 11(8), 769-788.
Chien, Y. H. (2014). Organ donation posters: Developing persuasive messages. Online Journal of Communication and Media Technologies, 4(4), 119-134.
Chiu, Y.-C. (2011). Probing, impelling, but not offending doctors: The role of the Internet as an information source for patients' interactions with doctors. Qualitative Health Research, 21(12), 1658-1666.
Chiu, Y.-C., & Hsieh, Y.-L. (2013). Communication online with fellow cancer patients:
Writing to be remembered, gain strength, and find survivors. Journal of Health Psychology, 18(12), 1572-1581.
Cho, H. (2012). Health communication message design: Theory and practice. Thousand
Clark, D. (2002). Between hope and acceptance: The medicalisation of dying. British Medical Journal, 324(7342), 905-907.
Crosby, R. A., DiClemente, R. J., & Salazar, L. F. (2013). Health behavior theory for public health: Principles, foundations and applications. Burlington, MA: Jones &
Bartlett Learing.
Davies, B., Sehring, S. A., Partridge, J. C., Cooper, B. A., Hughes, A., Philp, J. C., . . . Kramer, R. F. (2008). Barriers to palliative care for children: Perceptions of pediatric health care providers. Pediatrics, 121(2), 282-288.
De Bruijn, G. J., & Rhodes, R. E. (2011). Exploring exercise behavior, intention and habit strength relationships. Scandinavian Journal of Medicine and Science in Sports, 21(3), 482-491.
Detering, K. M., Hancock, A. D., Reade, M. C., & Silvester, W. (2010). The impact of advance care planning on end of life care in elderly patients: Randomised controlled trial. The British Medical Journal, 340, c1345.
DeVellis, R. F.（2003/2010）。量表編製：理論與應用（魏勇剛、龍長權、宋武譯）。 臺北市：五南。
Dijksterhuis, A., & Aarts, H. (2003). On wildebeests and humans: The preferential detection of negative stimuli. Psychological Science, 14(1), 14-18.
Douglas, R., & Brown, H. N. (2002). Patients' attitudes toward advance directives.
Journal of Nursing Scholarship, 34(1), 61-65.
Elias, N.（1982/2008）。臨終者的孤寂（鄭義愷譯）。臺北市：群學。
Etter, J. F., & Laszlo, E. (2005). Evaluation of a poster campaign against passive smoking for World No-Tobacco Day. Patient Education and Counseling, 57(2), 190-198.
Feifel, H. (1990). Psychology and death: Meaningful rediscovery. American Psychologist, 45(4), 537-543.
Making, 28(6), 834-844.
Flora, J. A., & Maibach, E. W. (1990). Cognitive responses to AIDS information the effects of issue involvement and message appeal. Communication Research, 17(6), 759-774.
Gallagher, K. M., & Updegraff, J. A. (2012). Health message framing effects on attitudes, intentions, and behavior: A meta-analytic review. Annals of Behavioral Medicine, 43(1), 101-116.
Gamliel, E. (2013). To end life or not to prolong life: The effect of message framing on attitudes toward euthanasia. Journal of Health Psychology, 18(5), 693-703.
Gawande, A.（2015/2015）凝視死亡：一位外科醫師對衰老與死亡的思索（廖月娟譯）。
臺北市：天下文化。
Geist-Martin, P., Sharf, B. F., & Ray, E. B. (2011). Communicating health: Personal, cultural, and political complexities. Belmont, California: Wadsworth Thomson Learning.
Gilaberte, Y., Alonso, J. P., Teruel, M. P., Granizo, C., & Gállego, J. (2008). Evaluation of a health promotion intervention for skin cancer prevention in Spain: The SolSano program. Health Promotion International, 23(3), 209-219.
Glanz, K., Lewis, F. M., & Rimer, B. K. (1997). Health behavior and health education:
Theory, research, and practice. San Francisco, CA: Jossey-Bass.
Gochman, D. S. (1982). Labels, systems and motives: Some perspectives for future research and programs. Health Education and Behavior, 9(2-3), 167-174.
Hagger, M. S., & Luszczynska, A. (2014). Implementation intention and action planning interventions in health contexts: State of the research and proposals for the way forward. Applied Psychology: Health and Well‐Being, 6(1), 1-47.
Harrington, N. G. (2015). Introduction to the special issue: Message design in health
Hartmann, P., & Apaolaza-Ibáñez, V. (2012). Consumer attitude and purchase intention toward green energy brands: The roles of psychological benefits and environmental concern. Journal of Business Research, 65(9), 1254-1263.
Hockley, J., & Clark, D. (2002). Palliative care for older people in care homes (facing death) Buckingham, UK: Open University Press.
Hsiung, Y. F. Y., & Ferrans, C. E. (2007). Recognizing Chinese Americans' cultural needs in making end-of-life treatment decisions. Journal of Hospice and Palliative Nursing, 9(3), 132-140.
Huang, C. H., Hu, W. Y., Chiu, T. Y., & Chen, C. Y. (2008). The practicalities of terminally ill patients signing their own DNR orders-a study in Taiwan. Journal of Medical Ethics, 34(5), 336-340.
Huck, S. W. (2012). Reading statistics and research (6th ed.). Boston: Pearson.
Iverach, L., Menzies, R. G., & Menzies, R. E. (2014). Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct. Clinical Psychology Review, 34(7), 580-593.
Johnson, K. S., Elbert‐Avila, K. I., & Tulsky, J. A. (2005). The influence of spiritual beliefs and practices on the treatment preferences of African Americans: A review of the literature. Journal of the American Geriatrics Society, 53(4), 711-719.
Kagawa-Singer, M., & Blackhall, L. J. (2001). Negotiating cross-cultural issues at the end of life: You got to go where he lives. JAMA, 286(23), 2993-3001.
Kahneman, D., & Tversky, A. (1979). Prospect theory: An analysis of decision under risk.
Econometrica, 47(2), 263-291.
Kalish, R. A. (1963). Some variables in death attitudes. The Journal of Social Psychology, 59(1), 137-145.
Kang, K. A., Lee, K. S., Park, G. W., Kim, Y. H., Jang, M. J., & Lee, E. (2010). Death
death education program. Korean Journal of Hospice and Palliative Care, 13(3), 169-180.
Kanouse, D. E. (1984). Explaining negativity biases in evaluation and choice behavior:
Theory and research. Advances in Consumer Research, 11, 703-708.
Kehl, K. A. (2006). Moving toward peace: An analysis of the concept of a good death.
American Journal of Hospice and Palliative Medicine, 23(4), 277-286.
Kenneth, C. C. Y. (2003). Internet users' attitudes toward and beliefs about internet advertising: an exploratory research from Taiwan. Journal of International Consumer Marketing, 15(4), 43-65.
Kerr, G., Schultz, D. E., Kitchen, P. J., Mulhern, F. J., & Beede, P. (2015). Does traditional advertising theory apply to the digital world? Journal of Advertising Research, 55(4), 390-400.
Kerr, J., Eves, F., & Carroll, D. (2000). Posters can prompt less active people to use the stairs. Journal of Epidemiology and Community Health, 54(12), 942-943.
Khalil, G. E., & Rintamaki, L. S. (2014). A televised entertainment-education drama to promote positive discussion about organ donation. Health Education Research, 29(2), 284-296.
Kraus, S. J. (1995). Attitudes and the prediction of behavior: A meta-analysis of the empirical literature. Personality and Social Psychology Bulletin, 21(1), 58-75.
Latimer, A. E., Katulak, N. A., Mowad, L., & Salovey, P. (2005). Motivating cancer prevention and early detection behaviors using psychologically tailored messages.
Journal of Health Communication, 10(1), 137-155.
Latimer, A. E., Salovey, P., & Rothman, A. J. (2007). The effectiveness of gain-framed messages for encouraging disease prevention behavior: Is all hope lost? Journal of Health Communication, 12(7), 645-649.
advertising effectiveness. Journal of Marketing, 25(6), 59-62.
Lazarus, R. S., 653-678. (1999). Hope: An emotion and a vital coping resource against despair. Social Research, 66, 653-678.
Leshner, G., & Cheng, I. H. (2009). The effects of frame, appeal, and outcome extremity of antismoking messages on cognitive processing. Health Communication, 24(3), 219-227.
Levin, I. P., & Gaeth, G. J. (1988). How consumers are affected by the framing of attribute information before and after consuming the product. Journal of Consumer Research, 15(3), 374-378.
Levy, C. R., Fish, R., & Kramer, A. (2005). Do‐Not‐Resuscitate and Do‐Not‐Hospitalize directives of persons admitted to skilled nursing facilities under the medicare benefit.
Journal of the American Geriatrics Society, 53(12), 2060-2068.
Line, D. (2015, 2015/10/06). 2015 Quality of death index. Retrieved April 28, 2016, from http://www.eiuperspectives.economist.com/healthcare/2015-quality-death-index
Loxterkamp, D. (1993). A good death is hard to find: Preliminary reports of a hospice doctor. The Journal of the American Board of Family Practice, 6(4), 415-418.
Madden, T. J., Ellen, P. S., & Ajzen, I. (1992). A comparison of the theory of planned behavior and the theory of reasoned action. Personality and Social Psychology Bulletin, 18(1), 3-9.
Maddux, J. E., & Rogers, R. W. (1983). Protection motivation and self-efficacy: A revised theory of fear appeals and attitude change. Journal of Experimental Social Psychology, 19(5), 469-479.
Maibach, E., & Parrott, R. L. (1995). Designing health messages: Approaches from communication theory and public health practice. Thousand Oaks, CA: Sage.
Marshall, C., & Rossman, G. B.（2010/2014）。質性研究：設計與計畫撰寫（二版）（李
Mason, P., & Butler, C. (2010). Health behavior change: A guide for practitioners (2nd Edition). New York: Churchill Livingstone/Elsevier.
McKinley, E. D., Garrett, J. M., Evans, A. T., & Danis, M. (1996). Differences in end-of-life decision making among black and white ambulatory cancer patients.
Journal of General Internal Medicine, 11(11), 651-656.
McSkimming, S., Myrick, M., & Wasinger, M. (2000). Supportive care of the dying: A coalition for compassionate care — conducting an organizational assessment.
American Journal of Hospice and Palliative Medicine, 17(4), 245-252.
Meyerowitz, B. E., & Chaiken, S. (1987). The effect of message framing on breast self-examination attitudes, intentions, and behavior. Journal of Personality and Social Psychology, 52(3), 500-510.
Millar, M. G., & Millar, K. (2000). Promoting safe driving behaviors: The influence of message framing and issue involvement. Journal of Applied Social Psychology, 30(4), 853-866.
Morgana, S., Millerb, J., & Arasaratnam, L. (2002). Signing cards, saving lives: An evaluation of the worksite organ donation promotion project. Communication Monographs, 69(3), 253-273.
Myers, R. E. (2010). Promoting healthy behaviors: How do we get the message across?
International Journal of Nursing Studies, 47(4), 500-512.
Neimeyer, R. A. (1994). Death anxiety handbook: Research, instrumentation, and application. Washington, DC: Taylor & Francis.
Neimeyer, R. A., Wittkowski, J., & Moser, R. P. (2004). Psychological research on death attitudes: An overview and evaluation. Death Studies, 28(4), 309-340.
Neimeyer, R. A. E. (2015). Death anxiety handbook: Research, instrumentation, and application. New York: Routledge.
strategies to raise public awareness of social determinants of health and population health disparities. Milbank Quarterly, 86(3), 481-513.
Nolan, M. T., & Mock, V. (2004). A conceptual framework for end-of-life care: A reconsideration of factors influencing the integrity of the human person. Journal of Professional Nursing, 20(6), 351-360.
Nozari, M., & Dousti, Y. (2013). Attitude toward death in healthy people and patients with diabetes and cancer. Iranian Journal of Cancer Prevention, 6(2), 95-100.
O'keefe, D. J., & Jensen, J. D. (2006). The advantages of compliance or the disadvantages of noncompliance? A meta-analytic review of the relative persuasive effectiveness of gain-framed and loss-framed messages. Annals of the International Communication Association, 30(1), 1-43.
O'Keefe, D. J., & Jensen, J. D. (2007). The relative persuasiveness of gain-framed loss-framed messages for encouraging disease prevention behaviors: A meta-analytic review. Journal of Health Communication, 12(7), 623-644.
O'Keefe, D. J., & Jensen, J. D. (2009). The relative persuasiveness of gain‐framed and loss‐framed messages for encouraging disease detection behaviors: A meta‐analytic review. Journal of Communication, 59(2), 296-316.
Oh, D. Y., Kim, J. H., Kim, D. W., Im, S. A., Kim, T. Y., Heo, D. S., . . . Kim, N. K.
(2006). CPR or DNR? End-of-life decision in Korean cancer patients: a single center’s experience. Supportive Care in Cancer, 14(2), 103-108.
Onwuteaka-Philipsen, B. D., van der Heide, A., Koper, D., Keij-Deerenberg, I., Rietjens, J. A., Rurup, M. L., . . . van der Maas, P. J. (2003). Euthanasia and other end-of-life decisions in the Netherlands in 1990, 1995, and 2001. The Lancet, 362(9381), 395-399.
Ö stberg, A. L., Halling, A., & Lindblad, U. (1999). Gender differences in knowledge,
Scandinavica, 57(4), 231-236.
Park, S. E., Choi, D., & Kim, J. (2005). Visualizing e-brand personality: Exploratory studies on visual attributes and e-brand personalities in Korea. International Journal of Human-Computer Interaction, 19(1), 7-34.
Parrott, R. (2004). Emphasizing “communication” in health communication. Journal of Communication, 54(4), 751-787.
Paul, B., Salwen, M. B., & Dupagne, M. (2000). The third-person effect: A meta-analysis of the perceptual hypothesis. Mass Communication and Society, 3(1), 57-85.
Peretti-Watel, P., Halfen, S., & Grémy, I. (2007). Risk denial about smoking hazards and readiness to quit among French smokers: an exploratory study. Addictive Behaviors, 32(2), 377-383.
Petroshius, S. M., & Crocker, K. E. (1989). An empirical analysis of spokesperson characteristics on advertisement and product evaluations. Journal of the Academy of Marketing Science, 17(3), 217-225.
Phelps, A. C., Maciejewski, P. K., Nilsson, M., Balboni, T. A., Wright, A. A., Paulk, M.
E., . . . Prigerson, H. G. (2009). Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer. JAMA, 301(11), 1140-1147.
Portenoy, R. K., & Bruera, E. (2003). Issues in palliative care research. New York:
Oxford University Press.
Quick, B. L., & Bates, B. R. (2010). The use of gain-or loss-frame messages and efficacy appeals to dissuade excessive alcohol consumption among college students: A test of
Quick, B. L., & Bates, B. R. (2010). The use of gain-or loss-frame messages and efficacy appeals to dissuade excessive alcohol consumption among college students: A test of