本研究之目的在探討女性接受試管嬰兒治療的決策歷程與決策品質。本研究以回溯性調查法訪談四十四位接受試管嬰兒治療之女性,將半結構式訪談指引所蒐集到資料以質性與量性的方法加以分析,並整合比較。根據研究結果與相關文獻佐證,得到下面數項結論: 一、接受試管嬰兒治療的女性,在面臨不孕症治療決策時,大多是依循著「聽從建議」、「且戰且走」的步伐在進行,而對於生育有「越來越醫療化」的態度。 二、接受試管嬰兒治療的女性,在決策上因為企求成功率高與快速的優點,傾向於願意承擔試管嬰兒治療對身體、經濟與時間的負擔。 三、大部分女性都認定自己有接受試管嬰兒治療的必要性;而對於不孕狀況嚴重度的認知,可能是對於接受試管嬰兒治療必要性的影響因素。 四、大部分接受試管嬰兒治療的女性,對不孕原因與治療過程的訊息有較高的需求,因而產生主動搜尋訊息的行動;而在主動搜尋訊息的行動中,有七成是藉由網際網路。 五、在最後決定接受試管嬰兒治療時,大部分女性缺乏與他人作有效的討論;這可能的原因是因為男性配偶未能主動積極參與決策所導致的。 六、女性在最後決定接受試管嬰兒治療時,在決策上的時間壓力並不大,但卻未花時間去作審慎的思考。這可能是因為在決策時,忽略試管嬰兒治療的負面影響。 七、女性在接受試管嬰兒治療時,大多能想到治療失敗的問題,並且對於失敗後的行動有規劃;對於治療失敗後能有行動規劃,可能是因為女性對於失敗將造成對生心理負荷有所認知的關係。 八、整體來說,女性在接受試管嬰兒治療的決策上,有一半以上在「知道其他解決不孕問題的方法」、「針對治療訊息作主動搜尋」、「與他人充分討論」以及「花時間考慮作最後決定」等方面未能達到決策標準,而這可能是影響女性整體治療決策品質不佳的較為重要的原因。 九、總結研究結果,女性在接受試管嬰兒治療的決策上,若能「對生育不抱持醫療化態度」、「瞭解自身不孕狀況的嚴重度」、「使用網際網路搜尋治療訊息」、「有男性配偶參與決策」、「考量試管嬰兒治療的負面影響」與「認知失敗將造成生心理的負荷」,相信能作出較為適合自己的好決定。 研究結果可提供臨床諮詢人員對於接受試管嬰兒治療的女性提供決策協助,使不孕症病患有更好的生活適應。 關鍵字:不孕症、試管嬰兒治療、決策歷程、決策品質。
Abstract This study is designed to investigate the decision-making progress and quality of women attempting in vitro fertilization. Forty-four women who have taken in vitro fertilization (IVF) were interviewed. The results showed: (1) When women with infertile problem decide whether to take IVF or not, most follow the suggestions with a “ try and see” attitude. And there is a higher tendency of “medicalization”. (2) Because of the desire of high success rate and the advantage of fast result, women tend willing to take physical, financial and time burdens of IVF. (3) Most women believe that there is a need for them to take IVF. And the understanding of seriousness of infertility condition might be the crux of deciding on IVF. (4) According to the higher desire to seek for the causes of infertility and to know the process of treatment, most women have taken proactive action to research information. And about seventy percents of them used Internet. (5) Most women do not have effective discussion with others while making final decision. This situation occurs probably because male spouses do not participate actively. (6) In making final decision, the time pressure is not heavy to women, but they do not spend enough time to deliberate. It might be caused by the oversight of the negative effects of IVF. (7) Most women can plan for the possible failure of IVF. And the reason of it might be the realizing of physical and psychological load that a fail IVF can bring to them. (8) In general, half of the women do not reach the decision’s criteria of “Understand other option of infertility-solving”, “Search for related information actively”, “ Full discuss with others” and “ Spend time to deliberate”. (9)”Keeping non-medicalization attitude”, “Understanding self’s infertility seriousness”, “Seeking information by Internet”, “Male spouse participating in decision-making process”, “Considering the negative consequence of treatment” and “Recognizing the effects when fails” might lead women to have a quality decision-making. Key words: infertility, in vitro fertilization, decision-making process, decision-making quality.