運用決策實驗室分析法探討內科住院醫師執行醫病共享決策之關鍵能力

Establishing the Professional Competencies of Internal Medicine Residents to Implement Shared Decision-Making Through the DMEATEL Method

黃煦恩(Hsu-En Huang) ； 連育誠(Frank Lien) ； 林靖麒(Jing-Chi Lin) ； 林科名(Ko-Ming Lin) ； 尤珊富(Shan-Fu Yu)

《內科學誌》 34卷2期 (2023/04) Pp. 111-123

https://doi.org/10.6314/JIMT.202304_34(2).06

摘要

醫病共享決策（shared decision making, SDM）是以病人為中心的照護理念，本研究目的旨在建構內科住院醫師執行SDM專業能力的評估指標。透過文獻回顧與專家諮詢，提出4大構面與16項準則，利用問卷調查，以嘉義與高雄長庚醫師作為收案對象，運用決策實驗室分析法，分析各構面與準則間之因果度和關聯度。整體構面分析，主要影響源為概念評估；單獨構面分析，主要影響源為概念、決策進行流程、語言及非語言溝通、追蹤醫療決策。從內科住院醫師視角，強化SDM概念評估是重要影響因素，透過系統結構關聯模式，有助於釐清內科住院醫師執行SDM所需具備的能力並提供改善策略。

關鍵字

醫病共享決策（shared decision making） ； 內科住院醫師（internal medicine resident） ； 決策實驗室分析法（decision making and trial evaluation laboratory） ； 專業能力（professional competence）

並列摘要

Shared decision-making (SDM) is a concept of patient-centered care. This study aims to construct an evaluation index for the professional competence of internal medicine residents to perform SDM. Literature reviews and expert consultation put forward four aspects and 16 criteria. Residents from Chiayi and Kaohsiung Chang Gung Memorial Hospital were enrolled utilizing a questionnaire survey. The causal relationships between each aspect and criteria were analyzed using the Decision Making and Trial Evaluation Laboratory (DEMATEL). The results demonstrate that the assessment of conception is the dominant aspect. Concepts, decision-making processes, verbal and non-verbal communication, and tracking of medical decisions are the dominant criteria for each aspect. From the viewpoint of internal medicine residents, SDM concept evaluation is a critical driving factor. Through the systematic network architecture model, it is helpful to clarify the professional competence of internal medicine residents to implement SDM and provide improvement strategies.