決策共享於癌症兒童照護之實務與挑戰

Shared Decision-Making in Care for Pediatric Patients With Cancer: Practices and Challenges

吳麗敏(Li-Min WU)

《護理雜誌》 69卷4期 (2022/08) Pp. 13-19

https://doi.org/10.6224/JN.202208_69(4).03

摘要

決策共享是以病人為中心的決策過程，目的是促進醫病相互尊重和溝通，透過醫療團隊提供不同處置的實證資料，再與病童和家人一起溝通討論彼此交流資訊，共同達成最佳可行治療選項的過程。因此決策共享是目前臨床照護的趨勢，透過醫療決策共享可以促進病童對於疾病的知識和降低治療衝突，但是目前的醫療決策共享計畫並未推廣至兒童和青少年。本文經由文獻查證後依決策共享理念和內涵，決策共享於癌症兒童之照護實務以及挑戰逐一說明，期望能增加醫護人員對於決策共享融入於癌症兒童之照護實務，以提昇以癌症兒童和家庭為中心的照護品質。

關鍵字

決策共享 ； 兒童癌症 ； 以家庭為中心照護

並列摘要

Shared decision-making (SDM) is a process of patient-centered clinical reasoning used to promote mutual respect and communication between doctors and patients. The medical team provides empirical data on different treatments. After communicating with patients and families, they discuss and exchange information with each other to achieve the best results from the available treatment options. Therefore, SDM is a current clinical care trend that may improve patients' disease knowledge and decrease treatment-related conflicts. However, SDM has not been extended to children and adolescents. This literature review article introduces the philosophy of SDM and practices and challenges of implementing SDM in children with cancer. We believe this article will enrich the clinical practice of SDM in children with cancer and improve related quality of care and family-centered care.

並列關鍵字

shared decision-making ； childhood cancer ； family-centered care

參考文獻

Aronson, P. L., Shapiro, E. D., Niccolai, L. M., & Fraenkel, L. (2018). Shared decision-making with parents of acutely ill children: A narrative review. Academic Pediatrics, 18(1), 3–7. https://doi.org/10.1016/j.acap.2017.06.009

Bahrami, M., Namnabati, M., Mokarian, F., Oujian, P., & Arbon, P. (2017). Information-sharing challenges between adolescents with cancer, their parents and health care providers: A qualitative study. Supportive Care in Cancer, 25(5), 1587–1596. https://doi.org/10.1007/s00520-016-3561-z

Christenson, K., Lybrand, S. A., Hubbard, C. R., Hubble, R. A., Ahsens, L., & Black, P. (2010). Including the perspective of the adolescent in palliative care preferences. Journal of Pediatric Health Care, 24(5), 286–291. https://doi.org/10.1016/j.pedhc.2009.07.001

Cicero-Oneto, C. E., Valdez-Martinez, E., & Bedolla, M. (2017). Decision-making on therapeutic futility in Mexican adolescents with cancer: A qualitative study. BMC Medical Ethics, 18(1), Article 74. https://doi.org/10.1186/s12910-017-0231-8

Coyne, I. (2008). Children’s participation in consultations and decision-making at health service level: A review of the literature. International Journal of Nursing Studies, 45(11), 1682–1689. https://doi.org/10.1016/j.ijnurstu.2008.05.002